Network Contracting Manager

Job Details

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.

Job Description

Primary 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.

Supervisory Responsibility:

This position does not have direct reports and may occasionally oversee other staff/vendors on a project basis to execute assigned responsibilities while assuring alignment of priorities and work product with business needs as defined by senior leadership. The position also takes a leadership role in the selection and hiring process.

Work from Home:

JHP allows employees to work remotely based on its determination that a remote work arrangement is appropriate based on JHP's business needs and the employee's ability to perform the job remotely in an effective manner. Should those business needs change, JHP reserves the right to change the remote working arrangement at any time, in accordance with JHP's Flexible Remote-Working Policy. JHP will provide a minim notice of 60 days of any change in the remote working arrangement.

Physical Demands

While performing the duties of this job, the employee is regularly required to talk and hear and sit for long periods of time.

Travel

Occasional local travel required for this position.

Work Location

This position is available to work from home; in accordance with our Flexible Remote-Working Policy, who you will be required to acknowledge and sign upon hire.

Key Job Requirements:

Education: Relevant bachelor's degree and/or 5-7 years equivalent combination of work experience.

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