Provider Network Contract Manager

Provider Network Contract Manager - 241034 DESCRIPTION/RESPONSIBILITIES: Bring your drive for excellence, teamwork, and customer commitment to Independence. Join us as we renew and reimagine the future of health care. Together we will achieve our mission to enhance the health and well-being of the people and communities we serve. Under the direction of the Director, Provider Contracting, this position is responsible for the fee for service contract design, development, negotiation and maintenance of hospital, physicians and ancillary services networks that reinforce our Medicare Advantage and Non-Medicare Advantage business goals and compliance. * Responsible for management of ancillary, hospital and physician contracts, including contract negotiations and ongoing management of contracting issues. * Leads negotiations with network providers, including responsibility for the end to end management of provider negotiations and ongoing contract management. * In conjunction with leadership, develops negotiation strategies based on assessment of baseline analytics, financial targets, contractual terms, Independence strategic objectives and industry trends. * Ensures provider contracting is consistent with claim payment methodologies. * Accountable for ongoing management of an assigned contract portfolio including assessment and resolution of issues, contract performance, monitoring unit-cost budgeting, ongoing provider engagement. * Ensures that non-standard contract elements are communicated to appropriate departments and obtains Plan approval prior to submission to provider. * To ensure contract terms are administered correctly, contract requirements are communicated timely and accurately to internal stakeholders and operational areas throughout term of each contract. * Coordinates with internal stakeholders (e.g. Care Management, Legal, Operations) to ensure identified issues are incorporated into negotiation objectives. * Works closely with network services team to ensure servicing issues are being resolved in accordance with contractual terms. * Communicates negotiation status to Director and senior leadership throughout process. * Assists in the development of FHN strategies, reimbursement methodologies and processes. * Builds and maintains positive relationships with counterparts in the Provider community. * Performs other duties as assigned. Education/Experience: * Bachelor's degree in business or health related discipline such as Healthcare Administration or Healthcare Management. Master's Degree preferred. * Minimum of 5 years hospital contracting/reimbursement experience in healthcare setting. * Excellent written and oral communication * Ability to demonstrate a high level of attention to detail * Experience with building relationships among key stakeholders * Able to occasionally travel to provider sites REQUIRED SKILLS: Hybrid Independence has implemented a "Hybrid" model which consists of Associates working in the office 3 days a week (Tuesday, Wednesday & Thursday) and remotely 2 days a week (Monday & Friday). This role is designated as a role that fits into the "Hybrid" model. While associates may work remotely on our designated remote days, the work must be performed in the Tri-State Area of Delaware, New Jersey or Pennsylvania. Independence Blue Cross is an Equal Opportunity and Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability. Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.

Created: 2024-11-05