Successfully manages the Managed Care Contracting prospective, renewal and termination negotiation processes as they relate to: Network Health, HMO/POS; third party administrators and self-funded employers, Accountable Care Organizations (ACO).
Accountable for establishing and maintaining positive relationships with internal departments, Network Health executive leadership and for any of the following prospective and/or existing external group: Network Health HMO/POS and third-party administrators.
Serves as the individual accountable for the overall relationship between Network Health and selected contracted providers.
Specific duties include establishing the initial contact with contracted providers setting and/or maintaining the tone for the desired Network Health provider agreements.
Conducts managed care contracting related research and analysis including developing compensation/reimbursement structures and contract terms/conditions.
Evaluates best-fit options for continued negotiations.
Prepare executive summaries and recommendations.
Initiates contract implementation process.
Maintains effective communication throughout contract terms and communicates contract updates and changes as needed.
Requests audits from the Provider File Specialist and evaluates contracting terms.
Provides leadership for department, and Network Health special projects

Bachelors degree in a related field is preferred or eight years of equivalent experience may be substituted.
Minimum of four years of experience in the health care industry (hospital, health insurance, or physician practice).
Minimum of two years health services negotiation and provider/customer service experience, preferably health insurance and/or provider.
Advanced health care financial, reimbursement and utilization data and analysis skills.
Working knowledge of medical terminology, health care billing/coding, reimbursement and insurance benefit methodologies.
Exceptional customer service/relationship management skills.
Ability to prioritize multiple tasks and projects.
Self-guided and motivated to achieve deliverables in a timely fashion.

Contract Manager

Key skills