You Will Focus On

• Effectively conducts negotiations with health plan and payer partners to achieve operational efficiency and budgeted results on a timely basis with moderate supervision:
• Conducts review of historical/potential financial performance of the contracts, using MLR financial reports and previous negotiation history.
• Prepares negotiation letters and sends them out in a timely manner to begin negotiations.
• Tracks negotiation history and creates rate comparison grids and other resources to show negotiation progress.
• Researches the effect of contract and financial terms with operating departments.
• Work with other departments to ensure operational concerns are addressed in new contracts.
• Ensures contract language abides by state and federal law and community standard.  Any deviations from language must be signed off by the appropriate department lead and/or Legal.
• Drafts and implements accurate and timely written communication pieces regarding new and renewed health plan payer arrangements and to the network and appropriate departments, including:
• Tracks all negotiations for senior executives.
• Communicates results of the finalized arrangement for presentation to internal departments as appropriate, i.e. some redacted versions.
• Solicits information and feedback from operating departments regarding, implementation and performance of contracts as required.
• Maintains all health plan payer contract data in a Health Plan Contract Summary grid or contract management database with reportable functionality.
• Develop and maintain successful relationships with Health Plan Payer partners and maintain a contact list of all levels of health play payer partner contracting staff.
• Participates in strategic and operational planning for the health plan payers and facilitates the execution of the plan.
• Act as liaison for resolution of problems related to the operations of all health plan contracts.
• Represent in meetings and collaborate at all levels to share updates, continuously improve operations, processes and partnerships.
• Maintain organization of health plan payer resources on intranet shared site, i.e. Provider Manuals, Contact List, Communication Notices, DOFR’s, Delegation Agreements, etc.
• Support Provider Contract negotiations, as necessary.
• Conducts organizational in-service/education of organization on health plan payer relationship and contract terms. 
• Performs all office functions accurately within reasonable limits based upon established needs and specified deadlines.
• Accepts and performs other related duties and responsibilities as required. 

The Skills & Experience You Bring

• Strong problem-solving, advanced communication and analytical skills required to develop positive working relationships both internally and externally.  Well developed negotiating and managed care operations skills required.  Training and Education skills strongly preferred.  Financial analysis skills and contracting regulatory skills strongly preferred. Strong written communications skills and strong Excel spreadsheet skills are required. Ability to multi-task and manage multiple projects simultaneously is required.
• BA or equivalent education and experience required
• Minimum of five (5) years of managed healthcare contracting experience necessary to have acquired and demonstrated skills and abilities listed above or the approved equivalent
• At least three (3) years working for a health plan or medical group/IPA