Contract Administrator, Value Based Initiatives

100 Albany Med Health System; Broadway (VA); On-site; USD 77,000 - 119,000; Full time

Job summary

Albany Med Health System is seeking a Contract Administrator, System Value Based Initiatives, to lead data-driven contracting efforts across AMHS and affiliated hospitals. You will develop payer strategies, analyze economic and risk data, and support negotiations with commercial and governmental payers.

This role requires building cross-functional relationships, preparing proposals, and delivering routine reporting on contract performance.

Qualifications

• Bachelor's degree in Business and/or Health Care Administration (required).
• Master's degree in Business and/or Health Care Administration preferred.
• 4-6 years in managed care negotiations and managed care network operations required; 1-3 years leading complex payer negotiations and mediation desired.

Responsibilities

• Negotiate contract parameters and methodologies with payers.
• Prepare contract proposals, presentations, and reviews for internal approvals.
• Coordinate input across Practice and Hospital Administration, Billing, Finance and other departments.
• Develop reporting instruments and monitor contract performance and profitability.
• Ensure compliance with contract provisions and mediate disputes to resolution.
• Monitor renewal dates and provide timely contract analyses with Finance.

Skills

Payer negotiations

Contract analysis

Stakeholder negotiations

Data analysis

Education

Bachelor's Degree in Business and/or Health Care Administration

Master's Degree in Business and/or Health Care Administration

Tools

Excel

Job description

Department/Unit: Integrated Delivery Systems Work Shift: Day (United States of America) Salary Range: $77,075.00 - $119,466.00

The Contract Administrator, System Value Based Initiatives (“Contract Administrator SVBI”) makes data-supported recommendations, supports the development of AMC/IDS AMHS contracting strategies, and, as assigned, negotiations/negotiates with established and new payers, both commercial and governmental. Support functions include but are not limited to economic and risk assessments in collaboration with Corporate System Finance and ensuring implementation and operational performance of such contracts, consistent with the negotiated terms. The Contract Administrator prepares contract proposals for internal review and consideration, prepares for and conducts meetings/negotiations, presentations, and other organizational functions as assigned. The Contract Administrator maintains strong relationships working collaboratively across AMC/IDSAMHS and payer organizations. This includes but is not limited to coordinating operational input across all applicable internal System departments including Practice and Hospital Administration, Billing, Finance, Information Systems, Utilization Management, Quality, Credentialing, Managed Care Organizations, payer, and other related internal and external entities. For each AMC/IDSAMHS contract portfolio the Contract Administrator assists with the development of reporting instruments including but not limited to contract performance parameters and/or profit/loss comparisons by service. The Contract Administrator works collaboratively within the Department to develop payer profiles to include but not limited to membership, market share, financials, products and volumes at AMC/IDSAMHS. This office is located at 43 New Scotland Albany New York. However, this position will be required to travel to our affiliate locations for scheduled meetings which include: The Saratoga Hospital, Glens Falls Hospital, Columbia Memorial Hospital.

Essential Duties

The Contract Administrator, System Value Based Initiatives meets with representatives of payers, managed care organizations and other agencies to assist in the evaluation of current contracts or development of new contracting opportunities, with focus on value based payment, to include those under Federal and NYS reform for AMHS. Reviews proposals and makes data informed recommendations for internal consideration in preparation for negotiations. In conjunction with the Director or at the direction of VP for Payer Contracting negotiates contract parameters and methodologies and prepares/presents proposals representing AMHS’s position. Works cross functionally across AMHS to evaluate and develop such proposals identifying opportunities and risks. Presents such opportunities and risks as directed. Collaborates with the Legal, Quality, and Compliance Department and other departments across AMHS to ensure compliance and implementation capabilities. Works cross functionally across AMHS to review terms and performance of each established contract portfolio; makes data informed recommendations for methodology changes including but not limited to those related to value based payment identifying opportunities and risks. Mediates contract disputes to resolution and ensures compliance (both internally and externally) with contract provisions. Monitors contract renewal dates to ensure appropriate review is conducted. Coordinates with Finance and others to ensure timely/applicable contract analyses. Reviews for risks and works collaboratively with Financial Reporting to ensure appropriate modeling. Understands all modeling parameters and reports on such. Responsible for contract education to various System-wide departments, including executive leadership, Finance, Billing, Quality, Clinical Departments, and Practice Administration as required. Responds to requests for further information and follow-up as required. Plans presentations and meetings including preparing narrative, overheads and handouts as assigned. Ensures accurate reporting in all prepared presentations for documentation/archiving. Monitors contract performance by independently collecting data, analyzing and completing spreadsheets to include comparative and economic assessments and reports on such. Works collaboratively with Data Analytics to develop routine reporting instruments for AMHS. Maintains broad knowledge of payers in the AMHS market and beyond, whether contracted or not. Assists with gathering of current data on all major managed care organizations, including information regarding: financials, current membership, physician networks and current/future marketing plans. Assists with the development of and prepares/presents reporting instruments for the AMHS. Maintains the absolute confidentiality of patients and AMHS contracts, Promotes and contributes positively to System-wide, intra-departmental and inter-departmental relationships by cooperating with the resolution of conflicts which may develop. Performs special projects and assignments as requested by the Director or VP for Payer Contracting. Assists with IDS Affiliate contracting processes related to payer contracting. Knowledge base must remain current in changes regarding Federal and New York State regulations of provision/reimbursement of medical services including but not limited to federal and NYS VBP Roadmaps.

Minimum Qualifications Bachelor's Degree in Business and/or Health Care Administration required Master's Degree in Business and/or Health Care Administration preferred Equivalent combination of relevant education and experience may be substituted as appropriate 4-6 years in managed care negotiations and managed care network operations required and 1-3 year in and able to lead complex payer negotiations and mediation.

Thank you for your interest in Albany Med Health System! Albany Med Health System is an equal opportunity employer.

This role may require access to information considered sensitive to Albany Med Health System, its patients, affiliates, and partners, including but not limited to HIPAA Protected Health Information and other information regulated by Federal and New York State statutes. Workforce members are expected to ensure that: Access to information is based on a “need to know” and is the minimum necessary to properly perform assigned duties. Use or disclosure shall not exceed the minimum amount of information needed to accomplish an intended purpose. Reasonable efforts, consistent with Albany Med Health System policies and standards, shall be made to ensure that information is adequately protected from unauthorized access and modification.

Albany Medical Center is the centerpiece of medicine, research, and medical education in New York’s Capital Region and is the area's largest private employer with more than 10,000 employees. Albany Medical Center offers excellent career opportunities in a wide range of roles in both patient care and administration. We value all our staff members and offer outstanding employee benefits including:

• Excellent health care coverage with no copay at Albany Medical Center providers
• A wide array of services and programs to support emotional, physical, and mental wellbeing

Anchored in the state’s historic capital city, Albany Medical Center offers a full range of inpatient and outpatient care and is home to the region’s largest hospital, only Level 1 adult and pediatric trauma centers, and only children’s hospital. The downtown campus also offers opportunities at Albany Medical College.

Albany Medical Center, along with Columbia Memorial Health, Glens Falls Hospital, Saratoga Hospital, and the Visiting Nurses, form the Albany Med Health System, serving more than three million people over 25 counties.