Sr. Contract Administrator, SPR

About the position

The Senior Contract Administrator will exhibit the highest level of professionalism, be service driven, detail oriented, proactive in training and messaging and possess excellent communication and analytical skills to support contracting and pricing initiatives. Serves as resource for Revenue Cycle Management, Compliance, and other business and/or clinical units. Communicates with outside payers and internal management staff. Maintains operational knowledge of contractual agreements and is able to assist with specific contractual language for service lines. Work involves application of advanced knowledge and skills related to essential job duties: e.g., knowledge of billing, reimbursement and contract terms and conditions to properly analyze revenue, identify variances and make recommendations for resolution. Duties may be varied and complex. May be asked to assist in formulating or revising Carilion policies and procedures. Compliance with regulatory controls and Carilion performance standards required.

Responsibilities

• Assists with research, negotiation, development, and maintenance of provider contracts and pricing rate setting for all network services.
• Strategic activities include extraction and evaluation of data, creation of reports, and submission of recommendations for improvements related to contract and pricing formulation.
• Negotiates with payers, performance monitoring, support of billing/collections, legal, compliance and other internal stakeholders.
• Assists with advanced research, negotiation, development, and maintenance of institutional and ancillary contracts for all the Clinic's assigned product and professional service categories.
• Develops negotiation strategies and planning with management and administration and conducts independent negotiations, as necessary.
• Acts as preceptor and mentor to the Contract Administrators.
• Consistently deliver the best in customer service and patient care.
• Evaluates risk and non-risk contractual arrangements between Carilion Clinic entities and third-party payors for the provision of healthcare services.
• Analyzes all aspects of contract proposals, including pertinent language, terms, conditions, related financial reports, and other data to determine feasibility and conformity to Carilion's goals and guidelines.
• Focused evaluation of documents to detect ambiguities, inaccuracies, omissions of essential terms, internal document conflicts, and to identify possible legal ramifications.
• Lead and support proposal preparation, contract negotiations, and administration of complex contracts.

Requirements

• Bachelor's degree in Business, Finance or Health Administration required.
• Master's degree in hospital or business administration, finance or closely related clinical discipline, preferred.
• Minimum of 4 years contracting experience.
• 2 years direct contracting experience within a hospital, consulting firm, accounting firm, or decision support vendor preferred.
• Requires a working knowledge of industry practices and negotiations of contracts including healthcare finance, fee for service contracts, DRG/Per Diems, Medicare CMS fee schedules.
• Excellent analytical and problem-solving skills.
• Clear, effective communication skills.
• Proficiency in PC and mainframe-based applications such as SQL, Tableau, Power BI preferred.
• Detail orientation.

Nice-to-haves

• Understanding of contract management and compliance requirements.
• Ability to adapt to changing work assignments and shifting priorities.
• Possess strong written and oral communication skills.
• Excellent interpersonal skills.
• Ability to conduct in-depth product presentations in a variety of settings.

Benefits

• Employer Funded Pension Plan, vested after five years (Voluntary 403B)
• Comprehensive Medical, Dental, & Vision Benefits
• Flexible Work Arrangements/Schedules
• Remote Work Options
• Paid Time Off (accrued from day one)
• Onsite fitness studios and discounts to our Carilion Wellness centers
• Access to our health and wellness app, Virgin Pulse
• Discounts on childcare
• Continued education and training