Manager-Provider Contracts

Baptist Memorial Health Care; Memphis (TN); On-site; USD 90,000 - 120,000; Full time

Job summary

A regional health care organization in Tennessee seeks a Mid-Senior level individual to oversee health care contracting. This role involves identifying, evaluating, and negotiating contracts to enhance provider networks. The ideal candidate will possess strong analytical and negotiation skills, as well as a minimum of 3 years experience in health care contracting. A bachelor’s degree in health care administration or business administration is required.

Qualifications

• 3 years experience with health care contracting and reimbursement.
• Proficient in health benefit plan designs and reimbursement methodologies.
• Strong presentation, negotiation and communication skills.

Responsibilities

• Identify and evaluate managed care contracting opportunities.
• Negotiate contracts with various providers and third-party payors.
• Maintain knowledge of managed care contracting concepts.
• Serve as liaison for contract communication.
• Manage renewal process for payor contracts.
• Acts as liaison for contract communications; manages contract document control.
• Manages renewal process for payor contracts, including renegotiation and utilization analysis.
• Performs other duties as assigned.

Skills

Analytical skills

Negotiation skills

Leadership skills

Verbal communication

Written communication

Education

Bachelor's degree in health care administration or business administration

Master’s degree in health care administration or related field

Job description

Job Summary

Identifies, evaluates and negotiates contracting opportunities to grow the existing business, develop new business, and expand provider network. In-depth understanding of health care and managed care contracting concepts, reimbursement, methodologies, and health benefit plan designs. Perceptive of general market conditions and the managed care market both provider and payor. Ensures application of appropriate business and legal protocol for contracting services to comply with organization and departmental missions. Serves as liaison for contract communication with other organizational representatives. Manages contract department, support staff, contract document control, and renewal process for payor contracts.

Job Responsibilities

• Identifies and evaluates managed care contracting opportunities to grow the existing business, develop new business with various third‑party payors, including insurance carriers, third‑party administrators, managed‑care networks, self‑funded payors, business alliances, and provider organizations, and to expand the provider network. Analyzes contract opportunities using contract guidelines to improve organization's market share.
• Negotiates contracts with various providers and third‑party payors, manages the interface to bring these negotiated contracts to closure, and informs senior management of contract activity.
• Maintains proficient knowledge of managed care contracting concepts (reimbursement methodologies, e.g., capitation, per diems, DRGs, case rates, discounted fee‑for‑service) and health benefit plan designs (PPO, POS, EPO, HMO). Extrapolates information from payors' health benefit plans and reimbursement arrangements to complete contract summaries, contract information load sheets, and other reports as required.
• Maintains current knowledge of the managed care market and trends, both provider and payor.
• Ensures that appropriate business and legal protocol is applied for contracting services to ensure compliance with organization and departmental missions; consults with legal on contracting issues.
• Serves as liaison for contract communication with other organizational representatives; manages document control of contract files.
• Manages renewal process for payor contracts, including renegotiation, and analyzes utilization data submitted for renewal to monitor contract performance.
• Performs other duties as assigned.

Experience

Minimum Required: 3 years experience with health care contracting with health care reimbursement and health benefit plan experience.

Preferred/Desired: (none specified)

Education

Minimum Required: Bachelors degree in health care administration or business administration.

Preferred/Desired: Masters degree in health care administration or related field.

Special Skills

Effective in making presentations to various provider and payor groups; strong analytical, negotiation, leadership, marketing, and verbal/written communication skills.

Seniority level

Mid‑Senior level

Employment type

Other

Job function

Management and Manufacturing

Industries

Hospitals and Health Care