ABOUT THE POSITION
We are currently seeking a dynamic Contract Manager to join our team at our office in Fairfield, CA, North Bay or East Bay, CA. The Contract Manager leads all territory network development and contract management activities for a growing and complex managed behavioral health care organization. The position is responsible for network development, recruiting for new business, contracting, and rate negotiations for their assigned territory. Duties include identifying and contracting new/ re-contracting existing providers around Beacon's need for services, negotiating rates, drafting provider services and facility agreements, sending and receiving credentialing applications, overseeing the resolution of language changes and securing executed contracts with providers, developing recruitment plans and reports and ensuring rates negotiated are within established guidelines.
Negotiates rates and contract terms with currently contracted providers and facilities.
In conjunction with internal and external stakeholders, secure executed agreements with identified out of network providers for inclusion in the Beacon Health network.
Performs reimbursement analysis on providers/facilities that are outside of the targeted rate schedule or performance standards and develop strategies for cost reductions, member needs and increasing quality.
Identifies opportunities for cost savings and process improvements related to the contracting process.
Review, draft and document suggested language changes, and oversee resolution of all proposed changes to the provider services agreement.
Ensures that Contract Language is in compliance with plan agreements and within all state and federal regulatory and NCQA standards.
Gather, review and submit credentialing applications, as required, for network development and management.
Provides general support to all network development activities and support Director with implementation requirements.
Strategizes with other members of the management team and client/plan to ensure access and availability of providers meets current standards.
Collaborates with other departments to address and resolve operational issues as related to negotiated contract language.
Education: High School diploma or GED required. Bachelor's degree preferred or equivalent experience in health care field.
Relevant Work Experience:
At least 3 years' experience rate & contract language negotiation to include facility and higher level of care experience; In-depth knowledge of all facility and some provider reimbursement methodologies- behavioral health experience a plus.
Knowledge, Skills & Abilities:
Knowledge of managed care contract requirements to include state and federal regulatory requirements for Medicare and Medicaid plans and CMS guidelines.
Location: Fairfield, CA, North Bay or East Bay
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Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled
Beacon Health Strategies, LLC