Contract Manager - Hosp/Physician group exp a plus - Hybrid schedule

Fallon Health; Worcester (MA); On-site; USD 90,000 - 130,000; Full time

Job summary

Fallon Health in Worcester, MA, seeks a Provider Contracting Analyst to manage and renegotiate contracts with hospitals and physicians. You will analyze financial data, design pricing models, and coordinate with internal teams to support provider relations and contract implementation.

The role requires 3+ years in managed care, strong analytical skills, and excellent communication. A bachelor’s degree is required, MBA/Healthcare Admin preferred.

Qualifications

• Three years minimum experience in managed healthcare with provider contracting, healthcare finance, reporting or provider relations.
• Excellent analytical, strategic and creative thinking skills are required. Superior verbal and written communication skills; proficient with Word, Excel, and Access.
• Bachelor’s degree required; MBA/Healthcare Administration/Public Health preferred.

Responsibilities

• Negotiate, develop and design contractual provider arrangements including language and pricing methodologies.
• Evaluate contractual payment methodologies to determine financial risk to insurer and provider; produce site financial and utilization reports.
• Perform quantitative analyses of financial and clinical data to evaluate contracting options.
• Coordinate and communicate with internal departments and manage operational issues related to provider contracts.
• Present recommendations to Manager regarding contractual and financial decisions.
• Maintain provider networks and contract databases; service and educate contracted providers.
• Assist in Provider Relations activities and respond to provider inquiries.
• Prepare and present financial reports to providers with recommendations for cost improvements.

Skills

Analytical skills

Strategic thinking

Creative thinking

Communication skills

Computer skills

Education

Bachelor’s degree or equivalent

MBA/Healthcare Administration/Public Health preferred

Tools

Word

Excel

Access

Job description

About us

Fallon Health is a company that cares. We prioritize our members—always—making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high‑quality, coordinated care and is continually rated among the nation’s top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self‑expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio‑economic status, and other characteristics that make people unique. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government‑sponsored health insurance programs—including Medicare, Medicaid, and PACE (Program of All‑Inclusive Care for the Elderly)— in the region.

Brief Summary Of Purpose

Responsible for the analysis, negotiation/renegotiation, implementation, readjustment, evaluation, and continuous improvement of all functions of provider contracting. Manages financial and operational issues related to contractual provider arrangements. Responds to both internal and external customers regarding provider contractual arrangements, both for contract implementation and ongoing operations.

Responsibilities

• Negotiates, develops and designs contractual provider (Hospital and physician) arrangements including language and pricing methodologies.
• Evaluates contractual payment methodologies in order to determine financial risk to insurer and provider (per diem, capitation, discount from charge, DRG, case rate, bundled payments, pay for performance programs, etc.). Ensures the design, production, and distribution of site financial, utilization and member information; ensures the production and completeness of annual site settlement reports. Interfaces between the Plan’s Finance department and individual sites for budget, financial reporting and settlement arrangements for all relevant products.
• Performs quantitative analyses of various financial and clinical data in order to evaluate multiple contracting options. Reports on performance of ongoing contractual arrangements to appropriate parties.
• Manages, coordinates and resolves operational issues related to specific areas of responsibility. Serves as contact person for internal departments (i.e. Claims, Finance, Care Management Services, Patient Relations, Marketing, Credentialing, Provider Relations, etc.).
• Researches, analyzes and presents recommendations to Manager regarding contractual and financial decisions.
• Manages provider correspondence relating to contracts and responds to requests from potential new providers for FCHP.
• Maintains computerized tracking system for new and revised agreements. Coordinates and communicates contractual information to appropriate departments within FCHP.
• Maintains assigned provider network; physician, hospital, ancillary, and/or carve‑out vendor as assigned by Director or Manager.
• Prepares, updates and maintains files and database for all assigned provider contracts.
• Serves as committee member in cross‑functional teams as assigned by Director or Manager.
• Assists in Provider Relations activities including servicing, educating and distributing information to contracted providers.
• Analyzes and presents financial reports to providers. Makes recommendations to providers regarding quality and cost improvements.
• Other duties as assigned.

Additional Performance Requirements

• Must be a team player with strong relationship building skills.
• Must be able to prepare and conduct formal presentations to small and large audiences both internally and externally.

Education

Bachelor’s Degree Or Equivalent Experience Required. Master’s degree in Business Administration, Healthcare Administration, or Public Health preferred. Previous background in nursing or any allied health field is often valuable but not required.

License / Certifications

Valid Driver’s License and Clean Driving Record Required.

Experience

Minimum of three years experience in managed healthcare environment(s) with related work in provider contracting, healthcare finance, provider reporting/profiling, and/or provider relations. Experience in provider contract negotiations, including FFS, capitation models, Hospital contracts and pay for performance models is preferred. Excellent analytical, strategic thinking, and creative thinking skills are required. Superior verbal and written skills, excellent computer skills (Word, Excel, Access) are essential to this position.

Pay Range Disclosure

In accordance with the Massachusetts Wage Transparency Act, the pay for this position is annually which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities.

Equal Employment Opportunity Statement

Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.