Contract Specialist Lead

Job Summary

Lead by example, holding positive and respectful relationships with highly-valued and complex internal and external customers.  The successful candidate will understand the nuances of managed care contracting, analytics, managed care payers, delivery system’s primarily operations, functions of a revenue cycle, and know where and when it is appropriate to engage senior leaders.  The candidate will also understand the latest healthcare trends and leverage their past years of experience to creatively design contracts that add value for Corewell Health. 

Lead tactically by helping junior staff with complex contract terms and negotiating techniques to help prepare for successful contract discussions.  The successful candidate will also lead administratively by managing internal communications as it relates to the contracting process and tracking success while driving key projects.  The candidate will also gather market and competitive intelligence through secondary sources as it relates to payers and providers and health care policy to increase knowledge providing leverage for the department to use in contract negotiations.

Essential Functions

• Manages the contract development and negotiations process for delivery system network initiatives.  Enters/maintains/oversees current information in the internal contract repository and system contract database.  Leads the proactive, methodical management of contracts from initiation through execution, compliance and renewal.

• Creates contracting strategies and deploys techniques that move payers to desired contract terms according to guidelines and preferred language.  Provides effective oversight of contract implementation process ensuring all contracts are within required guidelines and financial parameters and timely.
• Leads the drafting, review, negotiation, and execution of assigned payer contracts from start to finish.  Develops regular reports on contract milestones and performance; and informs internal customers of activities and progress, through both verbal and written communications. Interfaces routinely with leadership on an independent basis while understanding other political sensitivities.
• Applies critical thinking skills to analyze complex situations, identify root causes, and evaluate alternative solutions.
• Investigates operational, clinical, or administrative issues by gathering relevant data, conducting interviews, reviewing documentation, and assessing system processes.
• Formulates logical, evidence-based conclusions and make sound recommendations to resolve problems or improve outcomes.
• Collaborates with cross-functional teams to develop and implement corrective actions, ensuring alignment with organizational policies and goals.
• Monitors the effectiveness of implemented language and renegotiates as needed.
• Works with and involve relevant stakeholders (internal customers) as needed in negotiation decisions impacting legal or regulatory requirements, contract standards, cost targets and payment and pricing methodologies.  Facilitates contract implementation process with the appropriate internals teams, including payment rates, risk assignment, administration and other fees.  Work collaboratively with Business Intelligence and other internal staff to find solutions to provider issues concerning payment and operation procedures, etc, when necessary.
• Facilitates contract implementation process including payment rates, preferred language, risks, challenges, and operations of the contract.  Works with operations to find solutions to payment issues. Monitors contract performance and compliance by tracking key deliverables and timelines.
• Represents contracting at internal, external and Joint Operating Committee meetings.  May be requested to present and represent Managed Care Contracting updates/initiatives at meeting with internal/external constituencies.
• Leads through example and mentors junior staff on contract standards, processes, and systems.  Serves as the subject matter expert on Corewell Health's most complex contracts.

Qualifications

Required

• Bachelor's Degree or equivalent in Business Administration, Health Care Administration, Finance, Health and Human services or related degree programs.

• At least 10 years of experience within the healthcare system in either a payer or provider capacity in a direct, outward-facing role that includes data analytics
• 1 year of relevant experience in finance or contract management

Preferred

• Masters Degree in business administration, health care administration, finance, health and human services
• 2 years of relevant experience in a team lead or project management role responsible for personnel and their success
• Experience working with legal staff.