ESSENTIAL FUNCTIONS- Develop and maintain positive, effective relationships with internal and external customers and serve as the contracting liaison between contracted Payors and providers.
- Lead contract analysis and negotiations with Payors on behalf of providers including rates, payment methodologies, contract language and value- based payment programs in accordance with internal control processes for contract review, approval and signature.
- Lead development of Payor reimbursement analyses that can be routinely updated and maintained as a baseline for strategies to maximize health plan reimbursement and ensure payment integrity.
- Research and make recommendations to executive leadership in regard to payor contracting opportunities in new and existing geographic service area.
- Ensure compliance in all business and contractual relationships
- Identify and communicate trends and/or potential issues to market leadership and HOPCo management team.
- Lead development of infrastructure and analysis for strategic projects including rate transparency, payment validation and coordination with Revenue Cycle Management, payor contracting strategy including value based care glidepath.
- Other duties and responsibilities as assigned.
The job holder must demonstrate current competencies for job position.
EDUCATION - Bachelor's Degree in Business, Mathematics, Finance or Healthcare Administration required.
EXPERIENCE - Proven working knowledge of provider financial issues, complex contracting options, financial/contracting arrangements and regulatory requirements.
- 7-10 years related experience and comprehensive level of analytic and negotiating skills with successful track record supporting contract negotiations with payors.
- Strong communication, critical thinking, problem resolution and interpersonal skills.
- Solid understanding of industry dynamics required.
REQUIREMENTS - Familiarity with managed care products and services, medical cost trend analysis, including analysis of physician contracts, utilization, and costs.
- Must have prior experience working with managed care contracting modeling.
- Familiar with a variety of concepts, practices, and procedures in the field of managed care.
- Must be able to problem solve and come forward with recommendations.
- Must be able to stay on task with minimal supervision.
- Excellent critical thinking, troubleshooting, and analytical skills.
KNOWLEDGE - Knowledge of payor reimbursement.
- Managed care contracting.
- Market and industry knowledge.
SKILLS - Strong verbal and written communication skills.
- Strong organizational skills and careful attention to detail.
ABILITIES - Ability to analyze problems and interpret information.
- Able and to prioritize and reprioritize, as necessary.
- Ability to work independently, and as part of a team.
- Ability to multi-task, manages multiple projects, and meets tight deadlines.
ENVIRONMENTAL WORKING CONDITIONS - Normal office environment or Remote. Some travel within community.
PHYSICAL/MENTAL DEMANDS - Requires sitting and standing associated with a normal office environment.
- Some bending and stretching required.
- Manual dexterity using a calculator and computer keyboard.
ORGANIZATIONAL REQUIREMENTS - HOPCo Mission, Vision and Values must be acknowledged and adhered to
- OSHA Requirements and training to include: *Safety Training
This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve.
