Job description
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Day - 08 Hour (United States of America)
This is a Stanford Health Care - University Healthcare Alliance job.
A Brief Overview
The Provider Contract Manager will coordinate with the VP, Managed Care Operations in development, negotiation, implementation and monitoring of all managed care agreements. The Manager will act as facilitator with providers affiliated with managed care regarding issues pertaining to negotiation of reimbursement rates, contracting, reimbursement rules and others. In managing provider contracts, the Manager will work collaboratively with credentialing and billing teams as well as support special projects such as responses to regulatory inquiries and network expansion activities.
Locations
Stanford Health Care - University Healthcare Alliance
What you will do
A Brief Overview
The Provider Contract Manager will coordinate with the VP, Managed Care Operations in development, negotiation, implementation and monitoring of all managed care agreements. The Manager will act as facilitator with providers affiliated with managed care regarding issues pertaining to negotiation of reimbursement rates, contracting, reimbursement rules and others. In managing provider contracts, the Manager will work collaboratively with credentialing and billing teams as well as support special projects such as responses to regulatory inquiries and network expansion activities.
Locations
Stanford Health Care - University Healthcare Alliance
What you will do
- Development & Negotiation
- Engages targeted contracted providers in renegotiation of rates and/or language.
- Responsible for reviewing managed care contract language and negotiating language to meet agreed to parameters with finance and management to reduce risk and improve operational efficiencies.
- Provide feedback on contract renewals, renegotiation or termination; make recommendations regarding participation or nonparticipation with new or existing agreements; provide feedback to billing and management on financial and/or operational issues with payers.
- Evaluate and recommend financial parameters and reimbursement methodologies.
- Participates in fee schedule determinations including development of new reimbursement models.
- Implementation & Monitoring
- Maintains contractual relationships with significant providers.
- Keeps management apprised of developments in managed care marketplace.
- Develop and audit payer fee schedules based on negotiated reimbursement rates by contract and/or product line; coordinate the communication of fee schedules to management and departments.
- Seeks input on new reimbursement models from Network Management and legal.
- Evaluates provider network and implement strategic plans with the goal of meeting AMG’s network adequacy standards.
- Collaboration
- Act as liaison and collaborate with departments on managed care issues; work closely with licensing and credentialing I matters pertaining to physician credentialing applications and form; work closely with billing on payer enrollment issues and resolving discrepancies in billing statements related to physician credentialing and enrollment
- Educates internal customers on provider contracts.
- Participates on the management team and other committees addressing the strategic goals of the department and organization.
- All other duties as assigned including department-specific functions and responsibilities:
- Performs other duties as assigned and participates in organization projects as assigned.
- Adheres to safety, P4P’s (if applicable), HIPAA and compliance policies.
Education Qualifications
- Bachelor’s degree in health administration or computer science related field is highly desirable, or equivalent experience.
Experience Qualifications
- Three (3) years progressive experience in Managed Care (including Medicaid, Medicare/Medicare Advantage and other State governed plans)
Required Knowledge, Skills and Abilities
- High level of verbal and written communication skills with a strong capacity for detail, maintaining clear/effective contact with physicians, employees, administration and corporate personnel.
- Knowledge of managed care culture and philosophy.
- Specific knowledge of contractual, health insurance and operational issues related to managed care organizations, physician groups, hospitals and health insurance benefit plan designs.
- Proven negotiation and influencing skills
- Strong analytical and reasoning abilities
- Maintains confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA) and fraud and abuse prevention detection policies and procedures
- Strong organizational and planning skills to manage multiple priorities and meet required deadlines.
- Strong analytical, critical thinking and problem solving skills to ensure process improvement and projects are completed successfully.
- Proficient computer skills to include Microsoft Office (Word, Excel, and PowerPoint).
- Strong interpersonal skills necessary in order develop and maintain collaborative relationships with staff and physicians.
- Management skills necessary to attract and maintain a highly effective and motivated staff.
- Proven ability to work independently to produce accurate work of the highest quality.
- Manages relationships relevant to projects and requires the ability to gain cooperation of others.
Licenses and Certifications
- None
These principles apply to ALL employees:
SHC Commitment to Providing an Exceptional Patient & Family Experience
Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford’s patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery.
You will do this by executing against our three experience pillars, from the patient and family’s perspective:
- Know Me: Anticipate my needs and status to deliver effective care
- Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health
- Coordinate for Me: Own the complexity of my care through coordination
Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.
Base Pay Scale: Generally starting at $52.56 - $69.65 per hour
The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.
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