Senior Contract Administrator

Salary Not Available

Senior Contract Administrator

Neighborhood Health Plan

Location: Smithfield, RI - 02917

Positions available: 1

Job #: 37718600

Source: Recruit Military

Posted: 7/23/2024

Web Site: www.recruitmilitary.com

Job Type: Full Time (30 Hours or More)

Job Requirements and Properties Help for Job Requirements and Properties. .

Job Requirements and Properties

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Work Onsite

Full Time

Schedule

Full Time

Job Description Help for Partial Job Description. .

Job Description

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The Senior Contract Administrator is responsible for the end-to-end contracting process including, contract strategy development and negotiation through to execution with an emphasis on complex, high profile negotiations. This position develops, facilitates and implements provider negotiation strategies that support strategic and corporate goals. This position is responsible for the ongoing monitoring and management of contract terms including claims system configuration, contract oversight and adherence to all managed care health plan requirements. Provides support in the absence of a manager.

Duties and Responsibilities:

Responsibilities include, but are not limited to:

Responsible for complex, high profile negotiations, including the development, proposal and implementation of contractual terms as approved

Leads negotiations to completion and execute contractual relationships to align with specific corporate and department initiatives, strategic goals and objectives. Responsible for the accuracy of all contract and rate proposals and final contracts. Ensuring reimbursement is accurately defined, communicated and configured while maintaining network adequacy and member access to care standards and all Plan contractual requirements

Monitoring of contractual requirements through the ongoing management of contract terms including claims system configuration, contract oversight and adherence to all managed care health plan requirements

Assists in the development of the vision and strategy for the department and assigned functions including the identification, recommendation and recruitment of providers

Cultivates strong business relationships internally and externally

Ensures that providers receive appropriate and timely responses

Identifies and implements medical expense savings opportunities

Leads and collaborates departmentally and cross-organizationally in the development and planning of provider contracting initiatives and efficient business processes including recommending modifications to policy and procedures, processes, workflows and communication strategies

Provides assistance and mentorship to the Contract Administrator and support in the absence of the Manager

Provides reporting to internal and external parties

Represents the organization in appropriate internal and external committees and meetings and facilitate internal and external meetings, as required

Serves as the lead subject matter expert ensuring optimal efficiency in area of responsibility

Understands, proposes and implements various industry standard reimbursement methodologies as approved

Works collaboratively with provider relations to understand operational issues, providing assistance in the satisfactory resolutions as needed

Maintains professional growth and development

Works on special projects and other duties as assigned

Responsible for complying with Neighborhoods Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies and procedures as it applies to individual job duties, the department, and the Company. This position must exercise due diligence to prevent, detect and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents

Required:

Bachelors degree in Health Administration, Business Administration, Public Health or a related field or an equivalent amount of education and experience

Five (5)+ years experience with a managed care organization or a health care related organization (e.g. HMO, Medicaid, Medicare)

Three (3)+ years experience with commercial, Medicaid or Medicare contracting and reimbursement

Three (3)+ years experience with facility, professional, and/or ancillary contracting

Ability to travel including reliable transportation. If using personal vehicle, must have current, valid drivers license and proof of insurance.

Intermediate to Advanced skills in Microsoft Office (Word, Excel, PowerPoint, Outlook)

Demonstrated understanding and experience in contract development, negotiation, financial analysis, data analysis, provider reimbursement mechanisms, contract term implementation and maintenance of contractual terms

Ability to maintain confidentiality

Ability to manage data and processes in multiple platforms

Ability to manage multiple projects simultaneously

Ability to take direction and function within a team

Ability to work cross-organizationally to achieve the goals of the company and department

Demonstrated ability to successfully prioritize and organize own work to meet deadlines

Demonstrated experience speaking with the provider community, listening to grievances and communicating solutions with good follow-through skills

Demonstrated understanding of contractual language, health care delivery system, health insurance; insurance laws and regulations, including Medicare and Medicaid policies; claims processing; managed care principals, medical and insurance terminology and procedure and diagnostic codes

Excellent written and strong business communication and customer service skills (written and verbal) public relations, presentation and facilitation skills. Proven organizational skills and attention to detail

Knowledge of CMS, Federal and State laws and regulations and other applicable industry standards and benchmarks

Strong interpersonal skills; builds building high quality relationships internally and externally through actively networking

Working knowledge of facility reimbursement methodologies including per diem, case rate, bundled payments, and Prospective Payment System (PPS), including Diagnosis-Related Groups (DRG), Ambulatory Payment Classification (APC), Ambulatory Surgery Center (ASC), Resource Utilization Group (RUGs)

Working knowledge of facility contracting, including hospital, nursing facility, assisted living facility, adult day health care contracting

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