Job Description
Competitive Compensation & Benefits Package!Position eligible for –Annual incentive bonus planMedical, dental, and vision insurance with low deductible/low cost health planGenerous vacation and sick time accrual12 paid holidaysState Retirement (pension plan)401(k) Plan with employer matchCompany paid life and disability insuranceWellness ProgramsSee attachment for additional details.Office Location: Flexible for any of our office locations; Remote Option AvailableProjected Hiring Range: Depending on Experience Closing Date: Open Until FilledPrimary Purpose of Position:This position will provide management and oversight of the Medicaid Contract Unit. Work involves data entry and analysis, data mining, data management, reporting, record keeping, and providing, managing and coordinating the provision of a full range of support activities necessary for the effective management of contracting data for the department.Role and Responsibilities:The Contract Manager is responsible for all duties related to managing payor contracts, negotiation and renegotiation of new and existing payor contractsThis position works closely with members of the Provider Enrollment and Maintenance team to ensure contracts are appropriately identified, negotiated, implemented, audited and renegotiated in a timely mannerThis position requires prior knowledge of Managed Care in a Provider or Payor setting in addition to understanding of Payer Contracting tasks and activitiesProficient in the development, coordination and analysis of payor contractsResponsible for efficiently and effectively negotiating payment terms and rates for new and existing contracts that are favorable for the organizationProficient in the review of contract terms and conditions in order to facilitate accurate implementation of contractsResponsible for the maintenance of contract templates and approvals from NCDHHS to ensure compliance with the Tailored Plan and Medicaid Direct Contract requirements.Proficient in monitoring renewals of contacts as assigned and renegotiating contract rates and terms as appropriate upon renewalResolve escalated contract specific issuesSupervision and coaching of Contracts staff in complex, time-sensitive regulatory matters.Evaluate, understand, and negotiate provider contracts in compliance with company templates, reimbursement structure standards and other key process controlsInfluence and/or provide input to forecasting and planning activities for network growthManage performance target setting, performance reporting and associated financial models relative to provider network contractingEstablish and maintain strong business relationships with assigned providers and internal partnersDesign reports for internal and external recipients, which may require independent research.Work with internal departments to compile and analyze contract data and documentation for audit review & quality improvement.Produce and examine reports, gather and coordinate submission of State reports as mandated). Respond to requests from other Partners staff, particularly concerning provider status.Receive, review, analyze, track and maintain timely records of time sensitive and confidential information.Responsible for accurate and timely maintenance of provider information essential to Partners ability to accurately track network provider contracts; process authorizations and claims; and produce an accurate provider directory. It is critical that the staff person in this position be accurate and thorough in the completion of their duties.Failure to input accurate and complete information has the potential to negatively impact the service delivery system and consumer ability to access services in a timely manner.Participates in on-going quality improvement activities with other departments including UM, Claims, Care Coordination and IT.Knowledge, Skills and Abilities:Strong, working knowledge of data extraction methodologiesAbility to exercise appropriate judgement and discretion in presenting dataAbility to present complex data and information to varying audiences, both internal and external, in a professional and clear manner.Knowledge of program practices, techniques, and technology sufficient to support the programKnowledge of the goals and objectives of the work unit and an understanding of the structure and functions of the organization (must have knowledge of staff assignments/commitments, and the functions of other internal and external organizational segments whose work impacts on the unit or with which work must be interfaced)Excellent computer skills; proficient in Microsoft Office Products (Word, Excel, Outlook, Publisher); experience in use of databasesAbility to practice effective communication techniques, oral and writtenAbility to establish and maintain effective interpersonal and working relationships with internal and external customersAbility to analyze and interpret policy and procedural guidelines and to resolve problems and questions, independentlyAbility to complete non-routine activities and tasks that require deviation from established procedures which includes the ability to choose the appropriate course of action and recognize the existence of and differences among situationsAbility to use initiative and judgment in resolving problems not covered by established priorities or prior experienceAbility to recognize sensitive or unusual situations that should be referred to another more appropriate staff member or to the supervisorAbility to manage and uphold integrity and confidentiality of sensitive dataEducation/Experience Required:Undergraduate degree or three years Network management-related work experience. At least three years of experience in a network management-related role handling complex network providers with accountability for business results. At least three years of experience with direct provider contracting, including facility, physician, and ancillary providers. Experience with client-facing responsibilities, including issue resolution and contract negotiations.Other Requirement: Must reside in North Carolina or within 40 miles of the NC border.Education and Experience Preferred:Paralegal background preferred. At least five years of experience with direct provider contracting, including facility, physician, and ancillary. Experience in healthcare, especially public behavioral health, managed Medicaid, and healthcare payor systems and law.