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Manager Network Contracting

Manager Network Contracting
Company:

(Confidential)



Job Function:

Other

Details of the offer

JOB SUMMARY:
Manage the negotiation, development and administration of
hospital, physician, and/or ancillary contracts. Participate in the development of negotiation
strategies. Facilitate resolution of issues affecting contract provisions and
other operational issues that impact contracted providers. Participate in strategic departmental plans,
including business and organizational priorities. Ensure contracts, programs, plans, and
policies align with the company’s philosophy and objectives as well as meet all
regulatory requirements.

ESSENTIAL JOB FUNCTIONS:

Lead and oversee the work of hospital, physician, and/or
ancillary contracting functions and staff.
Lead and participate in the implementation and administration
of the company’s hospital, physician, and/or ancillary contracting strategy and
programs. Collaborate with internal departments to ensure execution is in
alignment with overall corporate goals and strategic direction.
Mentor and work directly with staff to manage department and
organization priorities and advise staff on negotiation strategy/progress,
including the direct negotiation of escalated provider contracts and issues as
needed.
Lead and participate in the execution of external provider
incentive programs and policies, (e.g., shared savings, pay for performance,
other alternative payment model strategies). Consult on the development of
aforementioned programs/arrangements as appropriate with other staff within the
division.
Consult with the internal departments on the development of
provider reimbursement strategies and models and partner with departments to
execute and implement reimbursement strategies.
Develop, maintain, and update corporate payment policies and
procedures relating to hospital, physician and ancillary provider contracting
activities as well as ensuring compliance with federal, state and accreditation
body requirements.
Represent the department and organization at various
internal and external negotiations, meetings and committees. Participate and
lead discussions on contracting, reimbursement issues, and strategies emanating
through multi-department directives and work efforts, while maintaining quality
contractual partnerships.
Develop and ensure adherence to goals and deadlines for
departments.
Perform other duties as assigned.

QUALIFICATIONS:
Minimum Education and Experience:

A combination of education and related experience
Five to seven years’ experience in managed care/insurance
contract administration either with an insurer or a healthcare provider
Three to five years’ management experience or experience
leading a team
Negotiation experience related to provider contracts and
network establishment and management

Preferred Education, Additional Qualifications and
Experience:

Experience working in a provider delivery system
Knowledge of or direct experience within the Rhode Island
provider community, including hospital and physicians

Required Knowledge, Skills, and/or Abilities:

Knowledge of industry standards of payment and medical
policy
Knowledge of hospital, physician and/or ancillary
reimbursement methodologies e.g. APC and DRG
Knowledge of hospital, physician and/or ancillary provider
coding e.g. CPT and HCPCS
Knowledge of health plan/provider economic models focused on
cost/quality accountability
Knowledge of health care plans, products, policies, and
procedures e.g. commercial, Medicare Advantage and Medicaid
Understanding of provider delivery system mechanics
Strong business acumen and political savvy
Ability to mentor, coach and provide guidance to others
Ability to collaborate while dealing with complex situations
Ability to think creatively and to drive innovation
Ability to influence up and across the organization
Ability to convert business strategy into action-oriented
objectives and measurable results
Ability to develop and manage a budget
Strong negotiating, influencing, and consensus-building
skills
At Blue Cross & Blue Shield of Rhode Island (BCBSRI), diversity and inclusion are central to our core values and strengthen our ability to meet the challenges of today's healthcare industry. BCBSRI is an equal opportunity, affirmative action employer. We provide equal opportunities without regard to race, color, religion, gender, age, national origin, disability, veteran status, sexual orientation, genetic information and gender identity or expression.
The law requires an employer to post notices describing the Federal laws prohibiting job discrimination based on race, color, sex, national origin, religion, age, equal pay, disability, veteran status, sexual orientation, and genetic information and gender identity or expression. Please visit http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf to view the "EEO is the Law" poster.
Apply Now


Source: Dayforcehcm

Job Function:

Requirements

Manager Network Contracting
Company:

(Confidential)



Job Function:

Other

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