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Overview

Manager-Provider Relations

Job Code: 22242

FLSA Status

Job Family: ADMIN SUPPORT

Job Summary

Identifies, evaluates and negotiates contracting opportunities to grow the existing business, develop new business and expand provider network. In-depth understanding of health care and managed care contracting concepts, reimbursement, methodologies, and health benefit plan designs. Perceptive of general market conditions and the managed care market both provider and payor. Ensures application of appropriate business and legal protocol for contracting services to comply with organization and departmental missions. Serves as liaison for contract communication with other organizational representatives. Manages contract department, support staff, contract document control, and renewal process for payor contracts.

Job Responsibilities

+ Identifies and evaluates managed care contracting opportunities to grow the existing business, develop new business with various third party payors, including but not limited to insurance carriers, third-party administrators, managed care networks, self-funded payors, business alliances and provider organizations and to expand the provider network. Analyzes contract opportunities utilizing contract guidelines in order to improve organization's market share.

+ Negotiates contracts with various providers and third party payors. Manages the necessary interface to bring these negotiated contracts to closure and inform senior management of contract activity.

+ Maintains proficient knowledge of managed care contracting concepts, including but not limited to reimbursement methodologies, e.g., capitation, per diems, DRGs, case rates, and discounted fee-for-service; and, health benefit plan designs, including PPO, POS, EPO and HMO. Extrapolates information from payor's health benefit plans and health care reimbursement arrangements to complete contract summaries, contract information loadsheets and other reports as required to meet organizational obligations.

+ Maintains current knowledge of managed care market and market trends, both provider and payor.

+ Ensures that appropriate business and legal protocol are applied for contracting services to ensure compliance with organization and departmental missions; consults with legal on contracting issues.

+ Serves as liaison for contract communication with other organizational representatives; manages document control of contract file.

+ Manages renewal process for payor contracts, including renegotiation. Analyzes utilization data submitted for contract renewal by following contracting guidelines to monitor contract performance.

+ Performs other duties as assigned.

Specifications

Experience

Description

Minimum Required: 3 years experience with health care contracting with health care reimbursement and health benefit plan experience.

Preferred/Desired

Education

Description

Minimum Required: Bachelors degree in health care administration or business administration.

Preferred/Desired: Masters degree in health care administration or related field

Training

Description

Minimum Required

Preferred/Desired

Special Skills

Description

Minimum Required: Effective in making effective presentations to various provider and payor groups; strong analytical, negotiation, leadership, marketing, and verbal/written communication skills.

Preferred/Desired

Licensure

Description

Minimum Required

Preferred/Desired

REQNUMBER: 31764