Contracting & Balance Billing Lead - Strategic Ops (Hybrid)

1199SEIU Benefit and Pension Funds; New York (NY); Hybrid; USD 120,000 - 160,000; Full time

Benefits offered by this job

Hybrid work model

Job summary

1199SEIU National Benefit Fund is seeking a senior manager to lead the Balance Billing & Fee Negotiation and Contracting team within Provider Relations. You will plan, strategize and oversee operations, manage NSA/IDR negotiations, and ensure contracting with facilities, vendors and providers aligns with regulatory guidelines.

The role requires extensive experience in managed care, strong negotiation skills, and the ability to drive compliance and efficiency across the organization.

Qualifications

• Bachelor's degree in business or health-related field required.
• Master’s Degree preferred.
• Minimum six (6) years relevant experience in managed care, contracting, and network management including four (4) year supervisory experience.
• Knowledge of fee negotiations, reimbursement methodology, and contract language review process.
• Broad knowledge of ERISA, DOL, HIPAA, PHI, ACA compliance.
• Excellent written, organizational and communication skills; detail-oriented.
• Knowledge of hospital and medical claims adjudication, billing terminology, and Medicare policies.
• Proven multi-tasking skills and ability to meet deadlines.
• Intermediate Microsoft Suite (Word/Excel) proficiency.

Responsibilities

• Plan, strategize and oversee daily operations of the Balance Billing & Fee Negotiation, and Contracting units under Provider Relations department.
• Oversee and manage NSA/IDR negotiations and rates for out-of-network hospital and medical services.
• Oversee contracting activities with facility types, vendors, and ancillary providers; enforce contract compliance.
• Maintain contract documents; ensure changes to templates are approved by Legal.
• Facilitate negotiation of contract rates and terms; capture, monitor and report metrics.
• Collaborate with outside fiduciary to implement rates for inpatient/outpatient hospital services; respond to provider issues.
• Manage staff according to department procedures and Collective Bargaining Agreement.
• Maintain integrity, ethical conduct and candor in communications.
• Collaborate with other departments to refine workflows and serve members.
• Perform additional duties and projects as assigned.

Skills

Contracting experience

Supervisory experience

Fee negotiations

Reimbursement methodologies

Communication skills

Multi-tasking

Deadline-driven

Microsoft Suite

Education

Bachelor's degree in business or health-related field

Master's degree

Tools

Microsoft Word

Microsoft Excel

Microsoft 365

Job description

1199SEIU National Benefit Fund is seeking a senior manager to lead the Balance Billing & Fee Negotiation and Contracting team within Provider Relations. You will plan, strategize and oversee operations, manage NSA/IDR negotiations, and ensure contracting with facilities, vendors and providers aligns with regulatory guidelines.

The role requires extensive experience in managed care, strong negotiation skills, and the ability to drive compliance and efficiency across the organization.