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011150 CCA-Network Contracting

Position Summary:

Under the direction of the Senior Contract Manager, Provider Contracting, the Senior Provider Contract Manager is responsible for developing, negotiating, managing and leading complex contractual, legal and

financial arrangements with providers that ensure CCA members have superior access to the highest quality, cost-effective providers of healthcare services.

Essential Duties & Responsibilities:

+ Develop, negotiate, manage and maintain provider contracts for a set of provider types, such as hospitals, PHOs, primary care or specialty physicians, behavioral health providers, ancillary providers (e.g. DME, skilled nursing facilities, rehabilitation hospitals, transportation providers, etc.) or long term services and supports (e.g. Aging Service Access Points, Independent Living Centers, Adult Day Health Centers, Adult Foster Care providers, etc.).

+ Lead complex negotiations and/or contracting arrangements which require developing a sound business strategy for the financial and legal terms required for such contracting initiatives.

+ Lead the research, development and implementation for new, creative and potentially complex reimbursement structures.

+ Assure contractual arrangements meet financial budgetary targets and legal and/or regulatory compliance requirements.

+ Maintain a solid understanding of Medicare and Medicaid reimbursement methodologies for assigned services.

+ Conduct on-going assessments of assigned networks and make recommendations for strategic initiatives, goals and objectives.

+ Develop and maintain strong provider partnerships.

+ Coordinate and communicate contractual terms to other departments whose functions are necessary to the development, implementation and management of the provider arrangements.

+ Lead and/or participate in cross functional meetings and projects specific to assigned provider types and serve as company-wide expert on services.

+ Assure high quality data entry of contract specifications and terms into contracting data bases and completeness of all contracting processes.

+ Assure network adequacy for required services meet all regulatory requirements and company growth targets.

+ Must be well versed in market place changes and related state political environment as related to assigned services.

+ Initiates cost savings recommendations.

+ Maintains excellent written and verbal communication skills with all internal and external customers.

+ Must be self-directed, exercise initiative, and seek guidance when appropriate.

+ Effectively and professionally represent CCA to provider community and all constituents of CCA.

+ Serve as a subject matter expert within the department and company-wide for services assigned and contracting issues in general.

+ Assist with Provider Contract Department projects, as needed.

+ Maintain high performance norms and actively participate in evaluation of own performance, establishing business goals and goals for self-development.

+ Assist Senior Manager and Director of Contracting and will represent the department when Senior Manager is unavailable or tasked to other duties.

+ May supervise staff and serve as a resource and mentor for other Contract Department employees.

+ Perform all other duties as assigned.

Working Conditions:

+ Standard office conditions.Position will require occasional automobile travel.

Required Education:

+ Bachelor's Degree or equivalent experience

Desired Education:

+ Master's Degree preferred

Required Experience:

+ 5-7 years

+ Experience working in a health care or managed care setting with specific background in contract negotiations and management.

+ Specific background in complex managed care provider contracting including Health Systems, Physician Hospital Organizations, Facilities and/or other high level and complex contracting required.

Required Knowledge, Skills & Abilities:

+ Comprehensive understanding of reimbursement methodologies and health care financing required.

+ Solid understanding of Medicare and Medicaid reimbursement methodologies and particular expertise in Medicare and Medicaid health care services contracting strategies.

+ Understands provider health care delivery systems both large and small, and is able to implement and

+ Perform complex contracting strategies and negotiations.

+ Ability to identify synergy between CCA and potential new and/or existing providers and effectively implement and maintain these provider partnerships for creative contracting initiatives.

+ Excellent written and verbal communication skills.

+ Exceptional provider partnership and interpersonal skills.

+ Strong contract negotiation skills.

+ Ability to design and deliver presentations to internal and external groups.

+ Particular expertise in Medicare and Medicaid health care reimbursement methodologies.

+ Knowledge of ICD-10 and CPT codes desired.

+ Results driven, able to self-direct and work independently as well as perform in a team environment.

+ Ability to multi-task, pay close attention to detail and be flexible in a fast paced and growing organization.

+ Ability to understand and set priorities, handle varying tasks simultaneously, and design work plans to track progress, resolve issues, and efficiently and effectively see tasks to completion.

+ Strong organizational and analytical skills.

+ Demonstrated strength in technical abilities such as excel, word, PowerPoint and other computer programs and data bases.

Language(s):

+ English

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled

Please note employment with CCA is contingent upon acceptable professional references, a background check (including Mass CORI, employment, education, criminal check, and driving record, (if applicable)), an OIG Report and verification of a valid MA/RN license (if applicable). Commonwealth Care Alliance is an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state or local laws.