Network Contract Specialist-Sr.

Independent Health Association•Buffalo, NY

5d•Hybrid

About The Position

The Network Contract Specialist-Senior shall be responsible for various aspects of hospital, physician, facility, laboratory, dialysis, and ancillary (herein collectively referred to as “Network Provider”) contract development and maintenance. This will include preparation and implementation of all Network Provider agreements and amendments and coordinating with credentialing and legal departments for network participation and contract completion. The Network Contract Specialist- Senior will be required to work with the Manager-Network Contract Management and members of the Legal Department to ensure that all contracts are compliant with all state and federal regulations. The individual will assist with the negotiation/renegotiations of contracts as needed. They will be required to maintain cooperative business relationships with providers and their counterparts in the provider community. The Network Contract Specialist-Senior will be accountable for researching and accomplishing Network Provider problem resolutions as required by NCM management and other internal departments. The Network Contract Specialist-Senior may be required to represent NCM on operational teams for certain administrative tasks.

Requirements

High school diploma or GED required.
Three (3) years of experience in legal and/or contracting field required.
Strong analytical and critical thinking skills that enable the individual to demonstrate decision making, process implementation, and recommendations to support organizational and team initiatives.
Proficiency in recognizing how decisions and processes implemented and designed within the business unit impact and interrelate with other internal business units and external stakeholders.
Excellent oral and written communication skills.
Strong organizational skills and ability to prioritize, multitask, and work in a fast-paced environment.
Project management skills with the ability to complete projects and assignments with minimal supervision.
Ability to understand, interpret and implement all aspects of provider contracts.
Ability to concisely and logically present complex issues verbally and in writing, to interact effectively at all levels and to listen carefully.
Strong interpersonal skills.
Effectively handle diverse assignments under shifting priorities and under tight time frames.
Proven examples of displaying the IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.

Nice To Haves

Bachelor’s degree preferred.

Responsibilities

Responsible for the development of provider contract agreements and legal documents.
Manage and secure that each agreement has proper language, appropriate lines of business, and integration of correct fee schedules (e.g. business and regulatory).
Monitor and maintain provider files and coordinate contract management to ensure executed contracts or amendments are current, compliant, and completed within set timeframe goals.
Identify and analyze information needed to support contract negotiations.
Prepare appropriate concise information for inclusion in contracts, amendments, letter of agreements or other binding documents.
Represent Network Contract Management department with compliance requirements to develop regulatory adherence processes and initiatives (for example, corporate initiatives, and compliance meetings).
Interpret and compile audit information requests from CMS, DOH, and internal department and develop comprehensive responses.
Peer review for assigned Network Provider (or other) documentation, to seek and ensure all outstanding information is received from team analyst and reimbursement teams.
Responsible for receiving provider requests and ensure the timely processing of requests including provider outreach and internal department inquiries; respond to provider inquiries for contracts, fee schedules or other.
Develop Network Provider network through identification of network need, provider outreach, secure positive relationships, and collaboration with Network Providers.
Contract implementation including coordinating analytics, lead operational tasks and deliver provider servicing.
Ensure that all provider contracts related resource payments and incentives are timely and accurate and that all paperwork is correctly submitted to accounts payable and is received by providers according to the contract provisions.
Collaborate with Family Choice of WNY on strategies for the implementation and program development in skilled nursing facilities as requested by NCM leadership. This will include initiating contractual arrangements, fee schedule implementation, network maintenance, and fostering relationships with Family Choice facilities.
Accountable for creating department reference tools, such as tip sheets, standard operating procedures, etc. to support efficiencies in specific team tasks.
Collaborate and provide support and communication with Credentialing, Legal, Provider Network Administration, Reimbursement, Utilization Management, Finance, Claims, Servicing, and other teams to ensure appropriate tasks are completed for new or existing provider implementations or initiatives.
Communicate effectively with both internal and external representatives.
Participate on cross-functional teams as requested.
Support the strategic goals of Manager, Director, and Senior Leadership in meeting corporate and strategic goals.