Contracts Manager, Provider

Altais

1d•$107,250 - $128,700

About The Position

At Altais, we’re on a mission to improve the healthcare experience for everyone—starting with the people who deliver it. We believe physicians should spend more time with patients and less time on administrative tasks. Through smarter technology, purpose-built tools, and a team-based model of care, we help doctors do what they do best: care for people. Altais includes a network of physician-led organizations across California, including Brown & Toland Physicians, Altais Medical Group Riverside, and Family Care Specialists. Together, we’re building a stronger, more connected healthcare system. About the Role Are you looking to join a fast-growing, dynamic team? We’re a collaborative, purpose-driven group that’s passionate about transforming healthcare from the inside out. At Altais, we support one another, adapt quickly, and work with integrity as we build a better experience for physicians and their patients. The Contracts Manager, Provider is responsible for maintaining Physician Network contracting efforts. Specifically, the position is responsible for AMG’s health care arrangements with both Primary and Specialty physicians and physician groups. Primary duties include contract analyses, negotiations and contributing to operational implementation.

Requirements

College degree or equivalent experience
5+ years of prior relevant experience in Contracts Management within a Provider space
Knowledge of CPT, ICD-9 and 10, DRG, HCPCS, RBRVS, and Provider Capitation is essential.
Must be highly organized with strong analytical and problem-solving skills.
Detail oriented with ability to manage projects from inception to completion.

Responsibilities

Effectively conducts negotiations with network physicians and physician groups, achieve contracting strategy and achieve budgeted results on a timely basis
Conducts review of historical/potential financial performance of the contracts.
Negotiate, recommend and maintains complex provider agreements and relationships.
Research the effect of contract and financial terms with operating departments, when applicable.
Conducts and/or defines negotiations of physician contracts, and Letters Of Agreement (LOA).
Ensures appropriateness of final documentation in accordance with HMO contracting guidelines (if applicable)
Work with other departments to ensure operational concerns are addressed in new contracts at the request of the Contracts Operations Manager.
Drafts and implements accurate and timely written communication pieces regarding new and renewed physician payer arrangements and to appropriate departments, including:
Communicates projected results of the finalized arrangement for presentation to operating, marketing and administrative departments as appropriate.
Conducts physician market research and provides market descriptions as needed for physician network expansion efforts.
Solicits information and feedback from operating departments regarding implementation and performance of contracts as required.
Identifies and implements AMG strategies and contracting methodologies to stabilize or decrease expenses.
Develop successful relationships with Provider Relations staff, and physicians and their office staff and act as liaison for resolution of problems related to providers including reimbursement and contracting by proactively identifying and responding to problems in a timely, accurate and professional manner.
Supports preparation of material related to network contract negotiations for final presentation and recommendation to VP, Sr. VP, CFO, President and physician members of the Contracting and Finance and or Physician Compensation Committees as assigned.
Represent Network Management Department on varying internal committees, as assigned.
Communicates positive marketing information regarding AMG client services, capabilities and developments to contracted network providers.
Under moderate supervision, oversee preparation of financial analyses related to financial and strategic decisions impacting AMG’ Network goals and initiatives.
Conducts ongoing departmental in-service/education aimed at elevating performance of and cross-training staff so as to provide adequate ability for the department to continue optimal functioning in the absence of one or more staff members.
Directs decisions of other company departments regarding payment and authorization determination, and benefit interpretation relevant to physician contract arrangements.
Completes projects within scheduled time frames and within established standards.
Updates the status of activities through use of department tracking tool.