Contract Manager

Brown & Toland Oakland , CA 94604

Posted 4 months ago

JOB DESCRIPTION:

JOB TITLE: Contract ManagerFLSA STATUS: Exempt

REPORTS TO: Director, Network ManagementDEPARTMENT: Provider Contracting

DATE: May 2015JOB GRADE: 15 JOB CODE: 502

POSITION SUMMARY:

Responsible for maintaining Physician Network contracting efforts. Specifically, the position is responsible for BTMG's health care arrangements with both Primary and Specialty physicians and physician groups. Primary duties include contract analyses, negotiations and contributing to operational implementation.

SUPERVISION:

This position does not supervise anyone.

ESSENTIAL JOB FUNCTIONS:

  • With moderate supervision, effectively conducts negotiations with network physicians and physician groups, achieve contracting strategy and achieve budgeted results on a timely basis:

a) Conducts review of historical/potential financial performance of the contracts.

b) Knowledge of CPT, ICD-9 and 10, DRG, HCPCS, RBRVS, and Provider Capitation is essential.

c) Negotiate, recommends and maintains complex provider agreements and relationships.

d) Must be highly organized with strong analytical and problem solving skills.

e) Detail oriented with ability to manage projects from inception to completion.

f) Researches the effect of contract and financial terms with operating departments, when applicable.

g) Conducts and/or defines negotiations of physician contracts, and Letters Of Agreement (LOA).

h) Ensures appropriateness of final documentation in accordance with HMO contracting guidelines (if applicable)

i) Work with other departments to ensure operational concerns are addressed in new contracts at the request of the Contracts Operations Manager.

  • Drafts and implements accurate and timely written communication pieces regarding new and renewed physician payer arrangements and to appropriate departments, including:

a) Communicates projected results of the finalized arrangement for presentation to operating, marketing and administrative departments as appropriate.

b) Conducts physician market research and provides market descriptions as needed for physician network expansion efforts.

c) Solicits information and feedback from operating departments regarding, implementation and performance of contracts as required.

  • Identifies and implements BTMG strategies and contracting methodologies to stabilize or decrease expenses.

  • With minimal supervision, develop successful relationships with Provider Relations staff, and physicians and their office staff and act as liaison for resolution of problems related to providers including reimbursement and contracting by proactively identifying and responding to problems in a timely, accurate and professional manner.

  • Under minimal supervision, supports preparation of material related to network contract negotiations for final presentation and recommendation to VP, Sr. VP, CFO, President and physician members of the Contracting and Finance and or Physician Compensation Committees as assigned.

  • Under minimal supervision, represent Network Management Department on varying internal committees, as assigned.

  • Communicates positive marketing information regarding BTMG client services, capabilities and developments to contracted network providers.

  • Under moderate supervision, oversee preparation of financial analyses related to financial and strategic decisions impacting BTMG' Network goals and initiatives.

  • Conducts ongoing departmental in-service/education aimed at elevating performance of and cross-training staff so as to provide adequate ability for department to continue optimal functioning in the absence of one or more staff members.

  • Under minimal guidance, directs decisions of other company departments regarding payment and authorization determination, and benefit interpretation relevant to physician contract arrangements.

  • Completes projects within scheduled time frames and within established standards.

  • Sets the example for an open and receptive attitude with employees.

  • Performs all office functions accurately within reasonable limits based upon established needs and specified deadlines.

  • Updates the status of activities through use of department tracking tool.

  • Accepts and performs other related duties and responsibilities as required.

QUALIFICATIONS & REQUIREMENTS:

  • Job related Knowledge, Skills, and Abilities, including Documentation, if pertinent.

Strong problem-solving, advanced communication and analytical skills required to develop positive working relationships both internally and externally. Well developed negotiating skills required. Training and Education skills strongly preferred. Financial analysis skills and contracting regulatory skills strongly preferred. Strong written communications skills and strong Excel spreadsheet skills are required. Ability to multi-task and manage multiple projects simultaneously is required.

  • Creative, Problem-solving, and Innovation Skills.

  • Customer Focused and Communication Skills.

EDUCATION AND/OR TRAINING:

  • Advanced knowledge of healthcare, managed care systems, HMO marketplace and market trends

  • Advanced knowledge of contract related activities including: negotiations, legal, regulatory, operational, finance and relationship management

  • BA or equivalent education and experience required; Contracting experience mandatory; basic financial analysis experience required

EXPERIENCE:

  • Minimum of three years of contracting experience in responsible positions in health care contracting necessary to have acquired and demonstrated skills and abilities listed above or the approved equivalent

  • Well-developed negotiating skills required

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Contract Manager

Brown & Toland