Job: Healthcare Provider Contract Manager

Jobing Description

Job Openings
Job Title: Healthcare Provider Contract Manager
Location: HealthSpan
225 Pictoria Drive, Suite 320
Cincinnati, OH 45246
Department: Operations
Date Posted: 9/13/2011
Shift: Full-Time
Additional
Information: The Contract Manager leads contract negotiations for approximately 15,000 physicians, 1000 allied health practitioners and 1500 ancillary providers in accordance with HealthSpan strategic expansion plan and network maintenance in Ohio, Kentucky and Indiana. Develops contract provisions for network contracts. Assists in the evaluation and development of health care provider reimbursement schedules. Monitors financial performance of contracts and identifies improvement opportunities. Participates in implementing a corporate-wide contracting strategy with department activities. Acts as a project manager for the evaluation of health care network projects. Manages and develops systems to implement and communicate Managed Care contracts throughout HealthSpan. Performs other duties as assigned by Management.

Manages contract development, processing, and negotiations with HealthSpan network of physicians, allied health providers, hospitals and ancillary providers and HealthSpan departments. Supports hospital contract development. Serves as liaison between network providers and Third Party Administrators that administer medical benefits and claims in addressing contract and reimbursement issues.

Manages the implementation process for provider reimbursement arrangements for HealthSpan network consisting of physicians, allied health care practitioners, hospitals and ancillary providers.

Develops contract language to secure network contracts with physicians, allied health providers, hospitals and ancillary providers. Assists with contract implementation and oversees maintenance of contract logs/system. Procures and disseminates updates. Facilitates resolution and troubleshoots administrative contracting issues. Analyzes and prepares routine reporting on provider contracting.

Maintain a good working relationship with the management staff of participating network providers (physicians, allied health providers, ancillary practitioners and their office staff) and informs company staff regarding contracting and operational updates from providers.

Maintains knowledge of current health care network reimbursement trends and developments in the various markets in Ohio, Kentucky and Indiana. Serve as a contracting expert in the payment methodologies for providers. Participates in the organizations and department s quality assessment and improvement activities.

Develops, secures approval of, and implements short-term and long-range initiatives that assist company in achieving outlined objectives in the company strategic business plan, including financial performance metrics.

Designs and implements educational processes and materials related to network contracting for providers, Third Party Administrators, Clients, and/or other parties.

Through the contracting process, develops and notifies providers of required changes such as rate increases, agreement changes, etc.

Analyzes and prepares routine reporting on provider contracting.

Serve as a contracting expert in the payment methodologies for providers.

Negotiates and completes the implementation process for provider reimbursement arrangements for HealthSpan network consisting of at least 15,000 physicians, 1000 allied health care practitioners, and 1500 ancillary providers.

Works with external Third Party Administrators to expedite claim inquiry resolution with
Providers.

Meets with providers to assure contract inquiry resolution including claims issues.

Maintains contract file for immediate resolution of contract questions.

Participates in the organizations and department s quality assessment and improvement activities.

Ensure compliance with the ORC HB 125 for HealthSpan Network of 15000 physicians, 1000 allied health providers and 1500 ancillary providers as required by Ohio Revised Codes.

Is responsible for all other duties as assigned.
Educational
Requirements: Bachelor s degree preferred, in business, healthcare management, finance or related field, along with a background in network development or contract management.

Three to five years contracting and negotiating experience involving complex delivery systems and organizations.

Knowledge of hospital managed care finance, claims payment, methodologies, procedures, controls and CPT, HCPCS, ICD-9, DRG coding preferred.

Effective negotiation and communication skills, plus the ability to utilize and interpret financial models and internal analyses.

Self starter and proven ability to work well in a matrixed environment.

Demonstrated project management skills with a successful track record.

Excellent interpersonal communication with the ability to influence at all levels of the organization.

Ability to adapt and become flexible in order to perform a variety of duties, often changing focus from one task to another of a different nature without loss of efficiency or composure.

Interpersonal skills requiring ordinary courtesy and tact are necessary to communicate in person and by phone with internal and external customers.

Work involves some travel to provider facilities, offices.

Work requires the ability to manage and prioritize multiple, time sensitive projects working under pressure for internal and external customers.

Able to adapt to change. Ability to quickly learn new skills and concepts.