Managed Care Contract Negotiator

Company :

Allegheny Health Network

Job Description : 

GENERAL OVERVIEW:

This position is responsible for negotiation and management of various third party payor agreements. Requires the individual to perform managed care contract negotiations and renegotiations with contracted and uncontracted third party payors.  This role partners with  analytics to create potential models for payor rate proposals. The incumbent develops relationships with internal departments (ex., Legal, Revenue Cycle), departmental leaders, service line executives, and others in order to identify and resolve payor and service issues.  This role reviews, edits, and proposes contractual rates and terms to be reviewed and approved before presentation to payor.  The incumbent possesses an understanding of healthcare reimbursement and revenue models (including population health and value based care), utilization and care management, and payor behaviors.  Requires excellent verbal and written communication skills, strong organizational abilities, and proficiency in Microsoft Excel and Word.

ESSENTIAL RESPONSIBILITIES

• Independently develops and proposes strategic modifications to existing contract language for renewals, leveraging a deep understanding of contractual implications and industry best practices.  For new agreements, critically reviews and amends proposed language, collaborating with leadership and legal teams to ensure optimal terms.  Proactively compiles comprehensive documentation for new agreements, ensuring alignment with strategic goals before presentation to payor. (30%)

• Strategically prepares for contract negotiations by independently analyzing existing agreements, assessing financial performance and market rates, scrutinizing volume data, evaluating payor performance against current  contract terms, and conducting comprehensive comparisons with similar agreements to identify opportunities for improved outcomes. (20%)

• Collaborates with the analytics team to develop innovative and data driven contract proposals that align with organizational objectives and market dynamics. (15%)

• Cultivates and manages critical payor relationships, proactively planning and facilitating Joint Operating Committee Meetings, independently resolving complex issues in collaboration with internal departments (e.g., Revenue Cycle) and the payor, maintaining consistent communication, and staying abreast of all relevant payor activities to anticipate and mitigate potential challenges. (15%)

• Leads high-stakes negotiations with payors, skillfully presenting proposals and defending contract language to achieve favorable outcomes for the organization. (10%)

• Provides strategic insights and comprehensive reports on negotiation activities, progress, and results to the leadership team, offering recommendations for future strategies and discussions. (10%)

• Other duties as assigned or requested.

QUALIFICATIONS:

Required

• Bachelor’s degree or relevant experience and/or education as determined by the company in lieu of bachelor's degree.  

• 6 years of experience in Healthcare Revenue Cycle, Finance, Reimbursement, or Managed Care Contracting

• 5 years of experience in developing contract language

• Epic Certified with in 9 months

• Healthcare Financial Management Association certification with in 1 year

Preferred

• Master's degree

• 5 years of experience in Negotiation

• 2 years of experience in Healthcare contract negotiation

SKILLS:

• Understanding of healthcare reimbursement methodologies

• Understanding of Value Based Care

• Skilled in Microsoft Excel and Word

• Understanding and familiarity with standard contract clauses and structure

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. 

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

$45.43

Pay Range Maximum:

$74.86

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations.  The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

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