Manager Physician Contracting

Excellus BCBS•Utica, NY

1d•Hybrid

About The Position

This position plans, directs and controls the contracting activities related to all professional (e.g., physician, dentist and non-physician including but not limited to psychologist, LCSW, podiatrist, audiologist etc.) and assigned ancillary (e.g., Homecare agency) services to assure that the Corporations act as prudent purchasers of services. This role is responsible for establishing and implementing corporate physician, non-physician and assigned ancillary contracting strategy, and developing and maintaining related contracting policies, practices, and standards across regions. Additionally, this position works with key stakeholders to ensure optimum contracting results and relations with the integrated hospital and physician entities in the region.

Requirements

Bachelor’s Degree in business, healthcare, finance, or relevant field required.
Minimum of 2-5 years’ experience in leadership of people or projects.
Prior experience supervising or managing people and/or projects or indirectly leading teams.
Minimum of 2-5 years’ experience in finance, actuarial, and/or negotiations.
Excellent communication and negotiation skills.
Ability to work constructively with external contacts including hospital administrators, owners of provider companies, physicians, provider organization leaders, and other providers of health and health related services and equipment.
Current and thorough understanding of health care, financial models, physician organizations, contracts, and the Corporations’ products, and must be able to effectively discuss these issues with others.

Nice To Haves

Master’s Degree preferred.

Responsibilities

Develops and implements reimbursement and negotiation strategies for all professional and assigned ancillary service providers.
Develops and maintains relationships with professional and assigned ancillary providers.
Establishes appropriate pricing and reimbursement strategies for professional and assigned ancillary service providers.
Oversees and coordinates annual community fee schedule updates.
Ensures Company acts as prudent purchaser of services.
Analyzes network needs for the professional and assigned ancillary networks.
Establishes and supports strategies to recruit providers and ensure provider adequacy as needed.
Works with other internal areas including but not limited to provider relations in developing best practice principles around contract negotiations and reimbursement.
Independently leads negotiations with professional and assigned ancillary provider types.
Assigns, monitors and provides oversight for team member negotiation activity.
Leads preparation and execution of legal contract templates and amendments and obtains appropriate and timely signoff from internal and external stakeholders.
Leads resolution process for any issues, questions, or decisions necessary to finalize documents and contracts.
Leads evaluation and resolution process for professional and assigned ancillary contractual disputes and disagreements.
Coordinates cross-functional resources to complete analysis, recommendations, execution, and validation of resolution(s).
Ensures adherence with contractual terms and performance.
Serves as escalation point for Provider Relations and other provider-facing colleagues to resolve provider concerns.
Develops, maintains, and enhances processes for contract management functions, such as identification of providers, mailings of contracts, obtaining signatures, credentialing, obtaining appropriate licensure information and contract renewal terms and timeframes.
Represents contracting during budget discussions and tracking for professional and assigned ancillary providers.
Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.
Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
Maintains knowledge of all relevant legislative and regulatory mandates and ensures that all activities are compliant with these requirements.
Conducts periodic staff meetings to include timely distribution and education related to departmental and Ethics/Compliance information.
Regular and reliable attendance is expected and required.
Performs other functions as assigned by management.