Contracting Manager

Chapters Health System•Temple Terrace, FL

1d•$82,786 - $124,179

About The Position

It’s inspiring to work with a company where people truly BELIEVE in what they’re doing! When you become part of the Chapters Health Team, you’ll realize it’s more than a job. It’s a mission. We’re committed to providing outstanding patient care and a high level of customer service in our communities every day. Our employees make all the difference in our success! Role: The Contracting Manager is responsible for the development, negotiation, and maintenance of payor/healthcare/clinical contracts enterprise wide and management of contracting department. Role will include responsibilities for all managed care and provider contract discussions/negotiations at its initial stages, assessing current contract performance data, the identification of specific revenue enhancement opportunities, re-negotiating contracts to improve financial outcomes/revenue, and managing the contract management software tool across the company and provider education activities of newly contracted and existing providers in assigned county service area.

Requirements

Bachelor’s degree with emphasis in Health Insurance/Healthcare Administration, Finance or Business preferred
Minimum of five (5) years’ related healthcare experience with three plus (3+) years in healthcare business and/or provider network development and contracting
Minimum of three (3) years in a managerial role/management experience preferred
Knowledge of managed care contracting required in any of the following settings: Long Term Acute Care, Skilled Nursing/Transitional Care, Inpatient Rehab, Home Health, PACE, and Hospice
Understanding of various payment methodologies and fee schedule administration within the hospital/outpatient, ambulatory and professional provider practice settings
Ability to develop and maintain excellent working relationships with both the internal team and external vendors
Business knowledge and competency in accounting and analysis
Working knowledge of regulatory requirements
Ability to work both independently and with a team
Able to work under minimal supervision, exercising discretion and independent judgment to solve problems
Team player and self-starter who is accurate and detail-oriented
Proficient in time management skills with the ability to prioritize a variety of duties

Nice To Haves

Experience working at a medical insurance company, MSO, IPA, TPA highly preferred
Experience working with IntelAgree contract management system preferred
Experience in establishing and/or developing productive and creative relationships with physicians/physician groups, hospital/health system administrators, and other health care industry leaders
Experience in payment methodologies and contracting in alternative payment models, shared savings and capitation
Preferable experienced with third party payor(s)

Responsibilities

Manages managed care and provider network contract negotiations and maintenance.
Oversees organizational/affiliate-level credentialing and re-credentialing with managed care plans/payors.
Responsible for all dimensions of contract administration, including negotiation, correspondence, documentation, certification, financial reporting, and product delivery for major contracts.
Coordinates approval of negotiation contract terms from proposal stage to project close-out in accordance with relevant regulations.
Coordinates approval of negotiations, contracts, and subcontracts with appropriate management staff.
Have the skills and experience to work independent through: The review of contract term and conditions.
Identify and advise of contract-related risks.
Assist in the preparation of proposal deliverables.
Interface with the client’s contracting official.
Develop and deliver contract and risk management training.
Monitor contract performance and assure compliance of the contract.
Evaluates network to address network adequacy requirements to support organizational growth.
Develops and maintain processes that provide timely notification of critical contract events (e.g., renewals, termination and due dates contained within the agreements).
Develop and maintain periodic, e.g., reports on the status of all contracts.
Conducts provider outreach by providing training and guidance to enable network providers to become more self-sufficient in confirming eligibility, claims submission/payment and authorizations.
Maintains positive relationships with network providers by conducting over the phone and/or onsite service calls to network participants on a regular basis.
Provides ongoing service/problem solving assistance to assigned providers as needed ensures all providers are updated on newly revised policies and procedures.
Contributes to the development, content, and maintenance of provider training manuals, provider orientations (group and individual), and other provider education resources.
Ensure accurate data entry of contract specifications and terms into database and completeness of all contracting processes.
Reviews provider directories for accuracy and completeness prior to publication and distribution.
Assists in the development of internal contract administration policy and procedure.
Demonstrates an understanding of basic managed care concepts and principles including Medicaid Managed Care, Medicare, Commercial HMO/EPO benefit programs.
Proactively supports Chapters Health network development/growth through development of new contracts with payers and service providers and expansion of services with payers and service providers that have existing contracts.
Lead the entire contract process from pre-contract through post-signature phases and closely collaborates with the Operations Director to ensure that operational leadership is informed of new contracts, changes to existing contracts, and updates to the medical and billing policies of the payers.
Performs other duties as assigned.