ESSENTIAL FUNCTIONS

• Develop and maintain positive, effective relationships with internal and external customers and serve as the contracting liaison between contracted Payors and providers.

• Lead contract analysis and negotiations with Payors on behalf of providers including rates, payment methodologies, contract language and value- based payment programs in accordance with internal control processes for contract review, approval and signature.

• Lead development of Payor reimbursement analyses that can be routinely updated and maintained as a baseline for strategies to maximize health plan reimbursement and ensure payment integrity.

• Research and make recommendations to executive leadership in regard to payor contracting opportunities in new and existing geographic service area.

• Ensure compliance in all business and contractual relationships

• Identify and communicate trends and/or potential issues to market leadership and HOPCo management team.

• Lead development of infrastructure and analysis for strategic projects including rate transparency, payment validation and coordination with Revenue Cycle Management, payor contracting strategy including value based care glidepath.

• Other duties and responsibilities as assigned.

The job holder must demonstrate current competencies for job position.

EDUCATION

• Bachelor’s Degree in Business, Mathematics, Finance or Healthcare Administration required.

EXPERIENCE

• Proven working knowledge of provider financial issues, complex contracting options, financial/contracting arrangements and regulatory requirements.

• 7-10 years related experience and comprehensive level of analytic and negotiating skills with successful track record supporting contract negotiations with payors.

• Strong communication, critical thinking, problem resolution and interpersonal skills.

• Solid understanding of industry dynamics required.

REQUIREMENTS

• Familiarity with managed care products and services, medical cost trend analysis, including analysis of physician contracts, utilization, and costs.

• Must have prior experience working with managed care contracting modeling.

• Familiar with a variety of concepts, practices, and procedures in the field of managed care.

• Must be able to problem solve and come forward with recommendations.

• Must be able to stay on task with minimal supervision.

• Excellent critical thinking, troubleshooting, and analytical skills.

KNOWLEDGE

• Knowledge of payor reimbursement.

• Managed care contracting.

• Market and industry knowledge.

SKILLS

• Strong verbal and written communication skills.

• Strong organizational skills and careful attention to detail.

• Advance computer skills.

ABILITIES

• Ability to analyze problems and interpret information.

• Able and to prioritize and reprioritize, as necessary.  

• Ability to work independently, and as part of a team.

• Ability to multi-task, manages multiple projects, and meets tight deadlines.

ENVIRONMENTAL WORKING CONDITIONS

• Normal office environment or Remote. Some travel within community.

PHYSICAL/MENTAL DEMANDS

• Requires sitting and standing associated with a normal office environment.

• Some bending and stretching required.

• Manual dexterity using a calculator and computer keyboard.

ORGANIZATIONAL REQUIREMENTS

• HOPCo Mission, Vision and Values must be acknowledged and adhered to

• OSHA Requirements and training to include: *Safety Training

This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve.