Hospital Contract Manager
Professional, Hospital Contract Program Manager, Network Contracting East/VT, Professional
Responsible for coordinating hospital and related professional and ancillary provider contract negotiation processes for the MVP East NY and VT regions, including:
·Negotiation of contract rates and terms for hospital and hospital system (related professional, and ancillary providers), including contract language and rates
·Manage provider performance initiatives / programs - hospital and professional pay-for-performance programs.
·Managing contract updates, amendments, data requisitions, tracking, reporting and all related ongoing contract business.
·Coordinates the data on cost, utilization and other data trends to support the negotiation process. Requires financial understanding of contract impact and changes against budgeted targets.
·Responsible for contract tracking and for coordinating with internal teams to ensure contract execution, provider credentialing / demographic updates, and claims system rate configuration.
·Handles follow-up inquiries regarding the new agreement.
·Uses Medicare, Medicaid and MVP proprietary reimbursement methodologies to analyze and assist with the negotiation and signing of new and renewed agreements in a manner needed to support MVP’s premiums.
·Requests / schedules data reports from internal support teams, takes an active role in evaluating data validity, comprehensiveness and data accuracy.
·Maintains a facility database of contracts, due dates, term clauses / end dates, spend and services by LOB. Keeps and maintains necessary database trackers and a tracking system for department and MVP report outs.
·Processes forms, tracks and scans signed/executed agreements and amendments.
·Responsible for integrity of hospital contract files. Develops and applies procedures and processes to safeguard data security in order to assure compliance.
·Reviews and revises network contract content with internal MVP departments and develops implementation plan to deploy contract changes and amendments accurately by due dates.
·Works with Legal Department on needed contract and amendment details such as contract language, correct versioning, dates, references and addresses.
·Prepares and coordinates documentation for network filings, product expansions, contract update, amendment mail-outs and mass-mailings.
·Serves as a key, initial contact person for internal and external business and payment inquiries. Evaluates request and looks to respond promptly within the expected turnaround time. Includes frequent urgent, ad-hoc MVP requests for Network to fill out or provide lists of specific contract content, assist with RFPs, etc.
·Individual will also train and mentor other contract team members.
·Candidate will have enough confidence and charisma toengage external providers on specific contract items so that MVP is communicating consistently within accepted timetables with the contracted network.
·Represents team in various internal / external meetings.
·Performs other duties as assigned - handles frequent requests from senior leadership
Bachelor’s Degree or comparable combination of education and related work experience required.
Must have three to five years’ work experience in negotiating and administration of hospital contracts and financial analytics with problem solving responsibilities.
• Experience in hospital and physicians’ reimbursement and/or network expansion on all lines of business (Commercial, Medicare and Medicaid).
• Working knowledge of relational databases including querying and reporting.
• Experience developing Excel/Access applications preferred.
• Ability to organize and present data effectively; detail oriented.
• Ability to work independently and prioritize to meet deadlines; internal and regulatory.
• Strong organizational, time management, oral, written and communication skills.
• Must have a high degree of personal initiative and able to work independently.
• Ability to interpret and negotiate terms, conditions and rate components of a facility agreement.
• Knowledge of technical contract reimbursement by lines of business: Medicare, Medicaid and Commercial.
• Ability to work cooperatively with other MVP internal departments.
• Must have reliable transportation, willing to travel occasionally throughout MVP’s service areas, with overnights as required.
• Excellent computer skills including working knowledge of Microsoft Office suite – Word, Excel, Outlook, PowerPoint, and Access.
Working knowledge of Facets claims payment system.
Must be self-organized and disciplined, a self-starter understanding workflow, processes and due dates.
Certified Coder (CPC, CIC, or CCS)
Must be committed to staying on track.
MVP Health Care is an Affirmative Action/Equal Opportunity Employer (PDF). We recruit, employ, train, compensate, and promote without regard to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, disability, genetic information, veteran status, or any other basis, e.g., Pay Transparency (PDF), protected by applicable federal, state or local law. Any person with a disability needing special accommodations to the application process, please contact Human Resources at email@example.com.
- Job Family Provider Relations
- Pay Type Salary
- Headquarters Office, 625 State Street, Schenectady, New York, United States of America