We currently have an opening for a Managed Care Contractor in our Melville, NY office. In this role the Managed Care Contractor, will report to the Director of Managed Care Contracting. Responsibilities will include:
- Assist in the strategic development and implementation of Managed Care, IPA, and Payor Contracts on a national, regional, and local level.
- Negotiate and renegotiate managed care and payor contracts consistent with contracting goals.
- Development of business decision support materials and proposals.
- Review and analysis of contract language and reimbursement terms in existing and potential managed care agreements.
- Cultivate relationships and maintain communications with health plans and payors.
- Prepare various reports to track and monitor financial performance of contracts.
- Assist to maintain and organize the managed care contracting database, disseminate contract rates and information to designated individuals for adherence to contract terms and definitions.
- Assist with the investigation and evaluation of payor markets in different states (payor mix, reimbursement issues, and state regulatory statutes).
- Prepare reports to review, assess and analyze utilization trends and overall performance of group contracts.
- Development and ownership of financial models to support contracting decisions, including modeling and analysis of innovative contracts.
- Demonstrate a strong ability to work in a team environment, promoting cross functional collaboration and creating strong morale in the team, through open dialogue and a cooperative atmosphere.
Additional Skills Required:
- Knowledge of current healthcare delivery systems, managed health care, and current regulations;
- Willingness to travel and work to “get the job done”;
- Strong negotiation, interpersonal skills, including written, verbal and analytical; ability to establish effective communications with internal and external stakeholders.
- Be a motivated and proactive strategist with the ability to adhere to deadlines; professional business sense and presentation skills; and must be able to take initiative and be a “self-starter” with the ability to prioritize work with minimal supervision.
- Strong knowledge of reimbursement methodology types (i.e. case rates; fee for service etc);
- Must be proficient in creating and utilizing MS Excel spreadsheets and all other MS Office programs;
- Bachelor's Degree required, and minimum of 10 years related experience.