ABOUT THE POSITION
The Contract Manager leads all territory network development and contract management activities for a growing and complex managed behavioral health care organization. The position is responsible for network development, recruiting for new business, contracting, and rate negotiations for their assigned territory.
Position Responsibilities:
- Negotiates rates and contract terms with currently contracted providers and facilities.
- In conjunction with internal and external stakeholders, secure executed agreements with identified out of network providers for inclusion in the Beacon Health network.
- Performs reimbursement analysis on providers/facilities that are outside of the targeted rate schedule or performance standards and develop strategies for cost reductions, member needs and increasing quality.
- Identifies opportunities for cost savings and process improvements related to the contracting process.
- Review, draft and document suggested language changes, and oversee resolution of all proposed changes to the provider services agreement.
- Ensures that Contract Language is in compliance with plan agreements and within all state and federal regulatory and NCQA standards.
- Gather, review and submit credentialing applications, as required, for network development and management.
- Provides general support to all network development activities and support Director with implementation requirements.
- Strategizes with other members of the management team and client/plan to ensure access and availability of providers meets current standards.
- Collaborates with other departments to address and resolve operational issues as related to negotiated contract language.
- Prepares reports and analyze data as directed by the Director of Provider Relations or other members of the management team.
- Adheres to all Beacon policies and procedures and standards of operations.
- Completes all required and assigned trainings.
- Attends all mandatory company or department meetings.
- Reports to each scheduled shift and commence work and perform essential job function at the start of each schedule shift.
- Displays a positive, constructive, and helpful demeanor that is conducive to a safe and respectful work environment.
- Acts as a mentor to junior team members by leading by example and guiding with a sense of integrity and team work.
- Assists management with identifying opportunities for staff improvement, high performing team members, and training needs of team members.
- Assist team members and offers suggestions to improve processes, culture, or work environment.
- Performs special projects and other duties as assigned and required.
Position Requirements:
- Education: Bachelor’s Degree required. Business, Finance or Healthcare Management preferable.
Relevant Work Experience:
- At least 3 years’ experience rate & contract language negotiation to include facility and higher level of care experience; In-depth knowledge of provider reimbursement methodologies- behavioral health experience a plus.
- Knowledge of managed care contract requirements to include state and federal regulatory requirements for Medicare and Medicaid plans and CMS guidelines.
- 2 (two) years of provider contracting, provider relations or similar experience
- Intermediate skill knowledge of electronic health record and electronic medical record software systems; FlexCare, Raintree, Connect preferable.
To Apply:
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Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled