Contract Administrator, System Payer Contracting

Department/Unit:

Integrated Delivery Systems

Work Shift:

Day (United States of America)

Salary Range:

$77,075.00 - $119,466.00

The Contract Administrator, System Payer Contracting (“Contract Administrator”) makes data-supported recommendations, supports the development of AMHS contracting strategies, and, as assigned, negotiates with established and new payers, both commercial and governmental. Support functions include but are not limited to economic and risk assessments in collaboration with System Finance and ensuring implementation and operational performance of such contracts, consistent with the negotiated terms. The Contract Administrator prepares contract proposals for internal review and consideration, prepares for and conducts meetings/negotiations, presentations, and other organizational functions as assigned. The Contract Administrator maintains strong relationships working collaboratively across AMHS and payer organizations. This includes but is not limited to coordinating operational input across all applicable System departments including Practice and Hospital Administration, Billing, Finance, Information Systems, Utilization Management, Quality, Credentialing, Managed Care Organizations, payer, and other related internal and external entities. For each AMHS contract portfolio the Contract Administrator assists with the development of reporting instruments including but not limited to contract performance parameters and/or profit/loss comparisons by service. The Contract Administrator works collaboratively within the Department to develop payer profiles to include but not limited to membership, market share, financials, products and volumes at AMHS.

QUALIFICATIONS

Education

Bachelor's Degree in Business and/or Health Care Administration

required

Equivalent combination of relevant education and experience may be substituted as appropriate

4-6 years in managed care negotiations and managed care network operations

required and 1-3 year in and able to lead complex payer negotiations and mediation.

This office is located at 1275 Broadway, Albany NY. However, this position will be required to travel to our affiliate locations for scheduled meetings which include: The Saratoga Hospital, Glens Falls Hospital, Columbia Memorial Hospital.

The Contract Administrator, System Payer Contracting meets with representatives of payers, managed care organizations and other agencies to assist in the evaluation of current contracts or development of new contracting opportunities to include those under Federal and NYS reform for AMHS. Reviews proposals and makes data informed recommendations for internal consideration in preparation for negotiations.

In conjunction with the Director or at the direction of VP for Payer Contracting negotiates contract parameters and methodologies and prepares/presents proposals representing AMHS’s position. Works cross functionally across AMHS to evaluate and develop such proposals identifying opportunities and risks. Presents such opportunities and risks as directed. Collaborates with the Legal and Compliance Department and other departments across AMHS to ensure compliance and implementation capabilities.

Works cross functionally across AMHS to review terms and performance of each established contract portfolio; makes data informed recommendations for methodology changes including but not limited to those related to value based payment  identifying opportunities and risks.

Mediates contract disputes to resolution and ensures compliance (both internally and externally) with contract provisions.

Monitors contract renewal dates  to ensure appropriate review is conducted. Coordinates with Finance and others to ensure timely/applicable contract analyses. Reviews for risks and works collaboratively with Financial Reporting to ensure appropriate modeling. Understands all modeling parameters and reports on such.

Responsible for contract education to various System-wide departments, including executive leadership, Finance, Billing, Practice Administration as required. Responds to requests for further information and follow-up as required.

Plans presentations and meetings including preparing narrative, overheads and handouts as assigned. Ensures accurate reporting in all prepared presentations for documentation/archiving.

Monitors contract performance by independently collecting data, analyzing and completing spreadsheets to include comparative and economic assessments and reports on such. Works collaboratively with Data Analytics to develop routine reporting instruments for AMHS.

Maintains broad knowledge of payers in the AMHS market and beyond, whether contracted or not. Assists