Job Description

THE POSITION:   The Provider Network Contract Administrator evaluates and negotiates contracts in compliance with company contract templates, standards, and other key process controls. Responsibilities include establishing and maintaining strong business relationships with Hospital, Physician, or Ancillary providers.  This position will report to the Manager of Contracting.

JOB SUMMARY:

• Nurture provider partnerships to seek broader opportunities including Risk, Value Based, Fee for Service, and provider specific contracts.
• Ensures effective implementation of new and renewing contracts through communication and coordination with other functional areas.
• Monitors provider contracts to ensure terms and conditions are met.
• Creates, negotiates and incorporates contract amendments, renegotiating the contract to accommodate scope changes or changes in organization requirements.
• Provides feedback to the appropriate management personnel when issues are identified relative to patient care, billing and authorization.
• Works closely with Quality, Claims and centers to identify and resolve operational issues relating to contract development, administration, and to facilitate quality of service and reimbursement.
• Responsible for the regular monitoring, collection, and reporting of performance metrics, territory profile reporting of field operations activities, and the coordination of activities.

BACKGROUND/EXPERIENCE:

• Minimum five (5) years of experience in Healthcare Administration, Managed Care Contracting or Health Care finance is preferred.
• 2-3 years network management-related role experience handling complex network
• Knowledge of Medicare and Medicaid regulatory requirements and practice protocols.
• Knowledge of quality assurance and utilization management concepts.
• Organized abilities and detail oriented.
• Able to work independently and as a team.
• Knowledge of claims processing systems and guidelines

DUTIES AND RESPONSIBILITIES:

• Research for new Providers, new Vendor leads, research for comparison contract pricing of physicians, consultants, and other vendors.
• Draft, manage, and negotiation a wide range of contracts including providers, commercial, and suppliers.
• Through communications, ensure all Providers are in compliance with current business and professional licenses, certifications and is not on exclusion lists.
• Manage renewal or termination of service agreements, and Provider contracts.
• Monitors contracts and enforces the contract terms.
• Performs other duties as assigned.

QUALIFICATIONS:

• Bachelor’s degree in Health Care Administration or related field or equivalent work experience required.
• 3-5 years’ prior experience in healthcare/managed care contracting, and/or healthcare finance required.
• Knowledge of healthcare contract administration.
• Knowledge of reimbursement methodologies and CPT, ICD10, and capitation.
• Certified Professional Contracts Manager (CPCM) a plus.
• Demonstrate excellent oral and written communication skills that are clear, concise and actionable and ability to communicate at all levels within the organization.
• Creative problem solver with a demonstrated ability to communicate specific barriers to the contracting process with recommended solutions.

The above job description is intended to communicate the general function of the mentioned position and by no means shall be considered an exhaustive or complete outline of the specific tasks and functions that will be required. Company reserves the right to change job descriptions, site assignments, and or work hours as required by the needs of the program. All employees are expected to perform their duties within their ability as required by the job and/or as requested by management.