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Manager Provider Contracting in Jacksonville, FL at One Call

Date: 8/22/2018

Job Snapshot

Job Description

Manager Provider Contracting
Responsible for the development, implementation and management of cost-effective provider contracting arrangements and network strategies, maintaining complex and geographically diverse contracts. Serves as mentor to Provider Contracting personnel, assisting in the development of network-wide strategies and contracts to improve efficiencies and access. Under the direction of the Vice President, Provider Contracting, s/he performs all critical functions necessary to assess, develop, maintain and/or improve provider contract adequacy and performance. 

GENERAL DUTIES & RESPONSIBILITIES:

• Design and effect necessary changes for strategic provider contractual quality or operational issues by adding, changing, or removing contractual requirements, standard operating procedures and work flows, computer system enhancements, and/or staff training
• Identify key and/or critically important providers, integrated provider systems, and provider networks with whom to develop mutually beneficial relationships
• Assess the providers' clinical, operational, and financial drivers to determine the feasibility and cost-effectiveness of potential
• Describe and support One Calls market and business drivers to providers in order to create mutually reinforcing value realization
• Lead negotiations for innovative and strategically contract alternatives & Important providers
• Forecast and describe key operational functions and data analyses necessary to support future provider contracts so the One Call’s work units can create complete, timely, and accurate work flows and support for provider networks and contractual provisions
• Analyze contractual language periodically, as well as the parties' obligations and overall relationships to ensure agile response to market conditions, necessary regulatory compliance, and adequate network access
• Maintain thorough knowledge of existing and emerging contract arrangements, regulations, and pricing trends; renegotiate contracts where improvements are needed
• Monitor contract performance of providers; analyze relevant reports; identify reporting, administration, reconciliation, and systems opportunities for improvement; and recommend enhancements so contracts can be administered accurately and ongoing provider performance can be effectively measured

 
EDUCATIONAL REQUIREMENTS:
Bachelor’s degree (B.A. or B.S.) and/or a Master’s degree (M.A., M.S. or M.B.A.) in Business or Accounting.  Minimum of five (5) years of experience in health care services. Three (3) years of management experience.  Five (5) years of experience in provider relations, vendor management or a related area.  A combination of equivalent education or experience.

GENERAL KNOWLEDGE, SKILLS & ABILITIES:

 Minimum of 10 years of successful provider contracting experience including: 
• Excellent provider relations experience and thorough knowledge of managed care practices and provider contracting, either in a provider or payor capacity
• Extensive experience and thorough knowledge of provider reimbursement methodologies, financial modeling, business analytics and reporting, provider coding and billing procedures, and related concepts and terminology
• Thorough knowledge of insurance terminology, concepts, and benefits issues, including actuarial and underwriting relationships to provider rates and services, member benefits, and cost sharing attributes
• Excellent verbal communication skills, including the ability to listen effectively, persuasive negotiation skills, and the ability to communicate both strategic and technical issues to individuals and in presentations to groups
• Ability to comprehend and interpret managed care contract terminology and thorough knowledge of quantitative analysis related to provider reimbursement
• Experience articulating and representing a compelling vision of an organization's strategic direction with provider relationships
• Management experience demonstrating effective leadership that results in achievement of desired results


PHYSICAL/EMOTIONAL DEMANDS & WORK ENVIRONMENTS:

• For roles located in office or home settings; this job is primarily sedentary and may involve repetitive motions; the employee is regularly required to sit, use hands and fingers, speak, and hear
• For roles located in the field; this job is primarily active; the employee is regularly mobile and must be able to utilize transportation (such as driving), sit, use hands and fingers, speak, and hear
• The employee is occasionally required to stand, walk, and lift objects (up to 10 lbs. weight; up to 4 ft. height)
• Specific vision abilities required by this job include ability to see things from a close distance and ability to adjust focus
• The work environment utilizes florescent lighting; noise level is moderate
• The emotional demand of the job may cause undue stress from, but not limited to, moderate/heavy workload
• Reasonable accommodations will be individually assessed and possibly made to enable individuals with disabilities to perform the essential functions of the position
• Please be advised the job description is subject to change at any time

Manager Provider Contracting

Intermediate managerial role – manages the coordination of the activities of a section within the department with responsibility for results, including costs, methods and staffing. Receives assignments in the form of objectives and determines how to use resources to meet schedules and goals. Provides guidance to team members within latitude of established company policies. Recommends changes to policies and establishes procedures that affect group. Works on issues of diverse scope where analysis of situation or data requires evaluation of a variety of factors, including an understanding of current business trends. Follows processes and policies in selecting methods and techniques for obtaining solutions. Acts as advisor to team members in meeting schedules and/or resolving problems. Develops and administers schedules, performance requirements, and may have budget responsibilities. Typically requires a minimum of 5 to 7 years of experience in a leadership role.