Sr. Contract Manager | BILH Performance Network
About The Position
The Sr. Contract Manager manages all payor contracting activities on behalf of Beth Israel Lahey Health Performance Network (BILHPN). The role is responsible for negotiating contracts and developing alternative reimbursement arrangements that support quality improvement and medical cost trend goals on behalf of BILHPN member hospitals and physicians. The position develops strategic negotiating targets and reimbursement models, prepares contract proposals, negotiates contract terms and pricing with the Senior Management team, and ensures that executed documents accurately reflect negotiated terms. It manages assigned payor relationships and contract portfolios, resolves operational issues, tracks contract performance and renewal dates, and maintains contract information. The role also analyzes reimbursement, risk models, publicly available data, regulatory and healthcare policy changes, and payor performance to inform negotiations and organizational strategy. It advises BILHPN staff and providers on contract terms, collaborates with hospital contracting staff and physician groups, and prepares and presents proposals, analyses, and performance reports to Senior Management and committees.
Requirements
- Bachelor's degree required.
- 5–8 years of related work experience required.
- Ability to travel to offsite locations as needed.
- Flexibility to attend early-morning or evening meetings.
- Advanced skills with Microsoft applications, which may include Outlook, Word, Excel, PowerPoint, or Access, and other web-based applications; ability to produce complex documents, perform analysis, and maintain databases.
- Ability to make decisions using general instructions and practices, interpret guidance, and recommend solutions to moderately complex problems.
- Ability to resolve highly varied, complex, and often non-recurring problems using staff input, creative approaches, and Lean diagnostic techniques.
- Ability to set goals and determine how to achieve results with some guidelines and broad Manager/Director guidance.
- Ability to communicate moderately complex information in English in varied written formats and comprehend and communicate complex verbal information in English.
- In-depth knowledge of relevant concepts, practices, and policies and ability to apply them in complex situations.
- Ability to lead small projects or work groups collaboratively and respectfully and improve workflows.
- Ability to provide professional, respectful, high-level customer service and remain calm in stressful situations.
- Ability to maintain close attention to work, concentrate for up to four hours without a break, and adapt to changing circumstances and new information.
- Ability to perform sedentary work, including constant sitting and keyboard use, with occasional carrying, lifting, pushing, or pulling of up to 10 pounds; walking and standing are occasional, and fine manipulation with one hand may be occasional.
- Must meet the employer's influenza vaccination condition of employment.
Nice To Haves
- Master's degree preferred.
Responsibilities
- Identify strategic targets for payor negotiations and propose and analyze options that support clinical and financial performance, including risk arrangements, fee-for-service rates, and infrastructure and quality support.
- Develop and update financial reimbursement models; prepare contract proposals with terms and pricing structures; and participate in negotiations with the Senior Management team.
- Ensure BILHPN-payor contract documents accurately reflect negotiated terms by editing and negotiating contract language, then manage execution and electronic filing.
- Serve as the primary contact for contract activities across an assigned payor portfolio, negotiate contracts to completion, manage payor relationships, resolve operational issues, and track contract performance and issues for renegotiation.
- Maintain expertise in hospital and physician reimbursement and coding and billing updates, and engage payors regarding changes that could negatively affect provider reimbursement or require renegotiation.
- Contribute to strategies for care coordination and contract terms across payor product types, including Medicare and Medicaid; design and conduct analyses of alternative risk models.
- Prepare and present payor proposals, analyses, and performance reports to Senior Management and committees.
- Monitor healthcare environment changes, including Health Care Policy Commission activity, federal and state regulations such as Chapter 224, and State Health Connector program changes; analyze public data to support negotiations.
- Advise BILHPN staff and providers on payor contract terms and interpretation, maintain the contract information database, and track renewal dates.
- Collaborate with BILHPN hospital contracting staff and physician groups to address contract issues and analyze participation and renewals to develop plans for consolidating PLLC and HLLC contracts into BILHPN contracts.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
