Job SummaryIndependently manages a portfolio of provider contracts and serves as an experienced Senior individual contributor for contract development, provider negotiations, implementation, compliance, and contract renewals. This role leads moderately to highly complex negotiations, evaluates financial and operational implications of contract terms, and partners with internal stakeholders to support our provider network, affordability, quality, and operational objectives. The Senior Provider Contractor applies strong judgment in managing provider relationships, resolving issues, and identifying opportunities for process improvement. This position is expected to work autonomously across a broad range of contract types and provider arrangements and provides guidance and training to less experienced contractors.
Essential Functions- Manages the contract development and negotiation process for provider networks initiatives. Maintains accurate contract documentation in internal repositories and systems.
- Deploys negotiation approaches to move providers to desired contract terms according to guidelines and standards. Oversees contract implementation of their agreements to ensure operational accuracy and compliance with approved terms.
- Acts as the principal contract negotiator for all assigned contracts. Manages contract review meetings to ensure delivery against objectives and contract budgets; monitors progress against objectives, timelines, and financial targets; and communicates status, risks, updates, and recommendations to internal stakeholders through verbal and written updates.
- Interfaces with provider leadership on an independent basis while understanding other organizational dynamics and stakeholder sensitivities of assigned groups.
- Works with appropriate internal stakeholders on negotiation decisions impacting legal or regulatory requirements, contract standards, membership, cost targets, and reimbursement methodologies. Facilitates contract implementation process with the appropriate operational partners and works collaboratively with internal teams on any contract related matters.
- Creates a customer-focused, service-based approach to working with stakeholders, which emphasizes the creation and cultivation of cross-functional relationships that support collaboration and execution.
- Represents contracting at internal meetings. Leads external meetings with providers and actively manages the contract negotiations and the progress of any contract related initiatives. May support network expansion and provider recruitment activities.
- Provides mentoring to less experienced team members; and models strong customer service, contracting discipline, and professional judgement.
QualificationsRequired
- Bachelor's Degree or equivalent
- Bachelor's Degree in business administration, health care administration, psychology, finance, health and human services
- 5 years of relevant experience Negotiating and managing contract lifecycles on behalf of either third party payers or health care providers
- 5 years of relevant experience Proven experience leading negotiations directly and independently or leading a provider contracting team in negotiations.
- Experience in finance or contract management and knowledge of CMS and commercial pricing practices and methodologies
Preferred
- Master's Degree
- Masters Degree in business administration, health care administration, finance, health and human services
- Experience working with legal staff Skills in best practices for contract negotiation tactics and strategies
- Working knowledge of anti-trust laws
Primary LocationSITE - Priority Health - 1239 E Beltline Ave NE - Grand Rapids
Department NameProvider Network Contracting - PH Managed Benefits
Employment TypeFull time
ShiftDay (United States of America)
Weekly Scheduled Hours40
Hours of Work8 a.m. to 5 p.m.
Days WorkedMonday to Friday
Weekend FrequencyN/A
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