Payer Compass is looking for a Provider Contracting Manager to be a key team player within our Member Advocacy Operations Team that is responsible for facilitating provider contracts including, but not limited to, Memorandum of Understanding (MOU) and Single Case Agreements (SCAs)
The Provider Contracting Manager’s primary focus/responsibility is to utilize/rely on experience to develop and implement effective/efficient policies and procedures for provider negotiations and contracting to include but not be limited to research, analyze, and review data to strategically work with providers to gain acceptance of health plans including self-insured plans and Reference Based Pricing (RBP) plans to build a Safe Harbor Community for members to access.
- Responsible for defining and executing provider contracting strategy and negotiating with providers.
- Conduct market analysis on provider recommended negotiating data points.
- Manage, analyze, and interpret complex data sets and apply findings to strategic initiatives.
- Develop strategy/process for identifying how the provider compares to other providers in the area as well as nationally relating to charges/quality/services offered
- Analyze current contracts in place in an effort to identify opportunities to expand these current provider relationships to other clients that may be a fit with this provider
- Implements strategic goals established by functional leadership.
- Assesses market trends and competitive benchmarks to enhance the company’s market position.
- Educate providers on health plans and plan payment methodologies.
- Analyze provider’s alternative proposals and compare to health plan current reimbursement methodology to determine overall effect for health plan
- Identify other avenues of analysis of the provider’s proposed contract terms (i.e., other average costs of services research tools, PPO discounts, etc.)
- Collaborates closely with Provider Partnerships, Medical Management, Provider Relations, Network Analytics, and Sales to meet aggressive goals.
- Improves and maintains highly competitive negotiated rates on all products and in doing so will ensure that a superior provider community is available to all employer groups.
- Facilitate discussions with providers and client partners to obtain provider acceptance and execute provider contracts.
- Document all outcomes within the Payer Compass Advocacy platform.
- Frequently responsible for providing guidance, coaching, and training to other team members across the Payer Compass organization within the area of expertise.
Education and Work Experience:
- Associates or bachelor’s degree preferred with a minimum of five years’ experience managing and working directly with providers on contracts and contract negotiations.
- Extensive experience with provider contracting for hospitals, physicians, allied and ancillary providers.
- Experience working directly with TPA clients/health plans in presenting and educating proposed contract terms
- Extensive knowledge in health insurance third-party administrator concepts related to compliance and business operations reporting needs in one or more of these programs: Referenced Base Pricing, Medicaid, Medicare Advantage, Exchange, and Commercial plans.
Knowledge, Skills and Key Competencies:
- Strong communication and facilitation skills, including interpersonal, oral, and written communication skills.
- Strong time management, attention to detail and organizational skills.
- Able to work independently and within a collaborative team environment with little guidance/supervision.
- 2+ years of computer skills, especially: Word, Excel, Visio, Power Point, and SharePoint
- 3+ years of experience leading projects and cross functional teams
- Ability to successfully balance deadlines, projects, and day to day responsibilities
Protects and maintains patient and institutional information in a confidential manner and in a secured environment. Ensures data access limitations through the use of password protection, read-only access, and other measures that protect the data from unauthorized or accidental access.