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Description:
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Responsible for all aspects of contract management in a healthcare marketplace company.
Duties and Responsibilities:
- Persuades providers to participate in company product line networks.
- Negotiates contract language and rates (i.e., fee schedules, per diems, capitation payment and other reimbursement methodologies) for the delivery of services from institutional healthcare facilities, medical groups and/or ancillary services.
- Re-negotiates with assigned providers for improved rates or terms. Develops and maintains effective business relationships with MBU or assigned region.
- Supports the MBU in marketing, program development/or product implementation through direct interface with provider networks.
- Works with providers to explain product lines and services, as well as policies and procedures.
- Keeps abreast of healthcare market place practices related to network services. Works with MBU, Actuary, Case Management, Legal, Information Technology, etc. to address rate proposals, payment structures, resolutions to network provider issues, contract language provisions, tracking and reporting enhancements.
- Participates with management in conducting network analysis and designing a network that is marketable across the MBUs.
- Develops and implements competitive market and service line negotiation strategies, in collaboration with MBUs/Actuary and other appropriate departments.
- Analyzes, models and negotiates financial arrangements and business/operational terms and conditions to meet cost management targets and business objectives of the organization.
- Manages a portfolio of large, complex or strategic contracts and provider relationships.
- Represents the organization as a primary spokesperson with assigned major healthcare providers.
- Works with complex financial data to propose different levels of reimbursement and methodologies under various types of contracts to resolve financial problems, differences & disputes, and reach agreement with hospitals, medical groups, IPAs and physicians, and/or ancillary services providers.
- Evaluates contract performance and makes recommendations to management within Network Services and MBUs.
- Monitors healthcare market place and internal utilization trends to assess new opportunities for cost savings, alternate delivery models and financial options.
- Leads/participates in various task forces related to network services.
- Provides consulting services to MBUs regarding network services needs or enhanced provider relationships.
- Assists in training other staff members within the unit/department.
Requirements/Qualifications:
- Has full technical, business and operational knowledge of healthcare delivery system and network services, including various reimbursement methodologies.
- 3-5 years contract management experience with strong proven negotiating and closure skills.
- Strong understanding of healthcare operations and delivery systems to include utilization management.
- Knowledge of various reimbursement methodologies to include per diems, discounts, capitation, etc.
- Knowledge of Finance.
- A Bachelor's Degree or equivalent experience.
- Depending on the level of Contract Management position, experience of contract negotiation in the Healthcare field, MS Office.
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