Network Contracting Manager - JHP

Jefferson Health Plans • Philadelphia, PA

3d • Remote

About The Position

Working under the direction of the Vice President, with minimal supervision, negotiates hospital and health system agreements, including associated physician and ancillary agreements, in building and maintaining high-quality and cost-effective provider networks to meet and exceed regulatory and organizational goals. Develops and maintains written contracts and analyzes hospitals and systems for reimbursement rates and contract language. Promotes value-based reimbursement components within hospital and system agreements as directed. Works with departments across the organization to develop support and approval for network contracting activities.

Requirements

• Relevant bachelor’s degree and/or 5-7 years equivalent combination of work experience.
• 3-5 years of hospital or ancillary contracting experience in a managed care setting (payer or provider based).
• Strong knowledge of hospital and provider reimbursement methodologies
• 3-5 years’ experience with Medicare, Medicaid, and value-based reimbursement methodologies preferred.
• 5-7 years’ Experience with provider recruitment, customer service and claims payment.
• In-depth knowledge of the managed care industry and practices, as well as a strong understanding of competitor strategies, practices, and financial/contracting arrangements.
• Excel at maintaining positive working relationships internally and externally.
• Superior organization and follow-up skills.
• Excellent written and oral communication skills.
• Strong quantitative analytic abilities.
• Careful attention to detail.
• Ability to represent Health Partners independently with external providers.
• Advanced knowledge of Microsoft Excel, Word, and PowerPoint preferred. Intermediate knowledge required.
• Knowledge of provider payment methodologies for Medicaid, Medicare and Commercial lines of business.

Responsibilities

• Leads or assists with assigned negotiations for hospital/health system contracts (i.e., hospital, physician, and ancillary) and ensures that negotiations meet the company's strategic and financial goals and objectives.
• Manage the negotiation of rates and language terms for existing and new physicians, ancillary, hospital/health systems, and other related provider agreements.
• Prepares contracts, contract amendments, rate proposals, and rate analyses.
• Facilitates and provides oversight for provider setup and contract configuration to ensure accurate system setup, fee schedule development, and accurate claims adjudication.
• Work with HPP management, other appropriate staff, and health systems to explore, develop, and implement innovative, value-based approaches to contracting.
• Coordinates with internal departments and contracted providers to implement and maintain contract compliance. Recommends operational changes or process improvements to appropriate stakeholders as required.
• Act as subject matter expert regarding physician, ancillary hospital, and health system contracts, and interpret and resolve business questions from network providers and internal customers.
• Recruit providers to meet network adequacy and marketability needs in alignment with health plan goals.
• Ensures that, during negotiations, contracts meet all regulatory requirements.
• Describes contract changes to other departments and reviews existing provider agreements to determine the need for creating new exhibits and amendments based on regulatory changes.
• Maintain and foster collaborative relationships with provider executives and internal and external customers.
• Develop and maintain monitoring tools for negotiated agreements.
• Performs job duties in compliance with applicable policies and procedures.
• He remains informed of industry trends related to physician, ancillary, hospital, and provider contracting and advises senior management of trends and issues that impact JHP.
• Serve as departmental representative/participant on interdepartmental and external work groups/task forces as assigned.
• May perform other duties as assigned.

Benefits

• Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts.
• Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service.
• All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Number of Employees: 501-1,000 employees