Provider Contract Manager

Why This Role is Important to Us:

The Provider Contract Manager is responsible for developing, negotiating and managing contractual, legal and financial arrangements with providers that ensure CCA members have superior access to the highest quality, cost-effective providers of healthcare services.

What You'll Be Doing:

• Develop, negotiate and maintain provider contracts for a set of provider types, such as hospitals, PHOs, primary care or specialty physicians, behavioral health providers, ancillary providers (e.g. DME, skilled nursing facilities, rehabilitation hospitals, transportation providers, etc.) or long term services and supports (e.g. Aging Service Access Points, Independent Living Centers, Adult Day Health Centers, Adult Foster Care providers, etc.)

• Assure contractual arrangements meet financial budgetary targets and legal and/or regulatory compliance requirements.

• Maintain a solid understanding of Medicare and Medicaid reimbursement methodologies for assigned services.

• Assure network adequacy for required services meet all regulatory requirements and company growth targets.

• Conduct on-going assessments of assigned networks and make recommendations for strategic initiatives, goals and objectives.

• Develop and maintain positive provider partnerships.

• Coordinate and communicate contractual terms to other departments whose functions are necessary to the development, implementation and management of the provider arrangements.

• Lead and/or participate in cross functional meetings and projects specific to assigned provider types and serve as company-wide expert on services.

• Must be well versed in market place changes and related state political environment in regard to assigned services.

• Assure high quality data entry of contract specifications and terms into contracting data bases and completeness of all contracting processes.

• Maintain excellent written and verbal communication skills with all internal and external customers.

• Must be self-directed, exercise initiative, and seek guidance when appropriate.

• Effectively and professionally represent CCA to provider community and all constituents of CCA.

• Assist with Provider Contract Department projects, as needed.

• Maintain high performance norms and actively participate in evaluation of own performance, establishing business goals and goals for self-development.

• Perform all other duties as assigned.

What We're Looking For:

• Bachelor's Degree or equivalent experience.

• Master's Degree preferred

• 3-5 years of experience

• Specific background in provider contracting in a health care or managed care setting required.

• Exceptional provider partnership and interpersonal skills.

• Strong contract negotiation skills.

• Ability to design and deliver presentations to internal and external groups.

• Particular expertise in Medicare and Medicaid health care reimbursement methodologies.

• Knowledge of ICD-10 and CPT codes desired.

• Results driven, able to self-direct and work independently as well as perform in a team environment

• Ability to multi-task, pay close attention to detail and be flexible in a fast paced and growing organization.

• Ability to understand and set priorities, handle varying tasks simultaneously, and design work plans to track progress, resolve issues, and efficiently and effectively see tasks to completion.

• Strong organizational and analytical skills.

• Demonstrated strength in technical abilities such as excel, word, PowerPoint and other computer programs and data bases.

• Position will require occasional automobile travel

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled

Please note employment with CCA is contingent upon acceptable professional references, a background check (including Mass CORI, employment, education, criminal check, and driving record, (if applicable)), an OIG Report and verification of a valid MA/RN license (if applicable). Commonwealth Care Alliance is an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state or local laws.