Manager, Physician Network Contracting (Hybrid)

Responsibilities

• Manage the activities of physician contracting which include preparing and maintaining contracts and complex contracting and negotiations for fee for service, and value-based reimbursements with providers (e.g., large physician groups)
• Draft single case Letter of Agreements and Long-term Letter of Agreements with providers and physician groups
• Develop reimbursement models and negotiate renewal agreements with large physician groups and independent provider associations (IPAs)
• Ensure timely response to provider inquiries related to contract terms and payment methodologies via email, telephone, written correspondence, and on-site/virtual meetings
• Reinforce contract terms with Physicians, internal Fund departments, escalate time sensitive issues and ensure timely communication on network updates and changes
• Facilitate review of escalated claims and evaluates contract terms and work with internal departments to obtain issue resolution within the prescribed timeframe
• Act as liaison between internal departments and ensure all contract language issues, problematic administrative terms and recommendations are tracked and issued annually prior to the contract re-negotiation period
• Manage projects including but not limited to Request for Information/Proposal, benefit changes, and other programs and initiatives as required
• Perform additional duties and projects as assigned by management

 

Qualifications

• Bachelor’s degree in Business or Health Care Administration required; Master’s degree preferred
• Minimum five (5) years of experience working in a healthcare management setting required; to include two (2) years supervisory experience required
• Proficient in Microsoft Word and Excel
• Excellent verbal, interpersonal and written skills
• Strong negotiation and influential skills and solid problem-solving skills
• Ability to travel throughout the New York metropolitan area
• Knowledge of provider contracting methodology including understanding of Accountable Care Organization (ACO) Model, Quality-Based Shared Savings Program (QSSP) and payor roles, responsibilities, and challenges
• Knowledge and thorough understanding of government regulations and requirements as they relate to physician contracting
• Ability to work in a fast-paced environment and foster positive working relationships, multi-task and meet deadlines

The first six months of this position will be 100% in the office for newly hired employees.