Excellus BCBS
Senior Manager Contract Negotiation - 007529 (Personal Services)
Summary:
This position is responsible to negotiate, plan, manage and control the activities related to assigned provider contracts. Ensures that the Company act as prudent purchasers of services by developing, maintaining, and enhancing contractual and payment relationships with all assigned providers. Acting under oversight of the Contract Negotiation Director, this role has the authority to negotiate the contractual obligations, make concessions, and establish other adjustments and arrangements between the Company and its providers, within established budget and other operational parameters. As delegated, this role may finalize all contracts under his/her assigned area.
Essential Responsibilities/Accountabilities:
· Evaluates and negotiates contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls. Has authority to act and speak on behalf of the company within delegated parameters.
· Recruits, hires, trains, manages and develops contracting support staff.
· Recommends alternative schemes and schedules to management as a solution to difficult contract negotiations. Implements approved solutions in accordance with company policy.
· Help set the budget and plan for contracts for individual hospitals and providers based on critical knowledge and information about the individual or group that is being negotiated.
· Develops and implements reimbursement and negotiation. Develops and maintains effective relationships with providers.
· Analyzes needs for various networks and negotiates with non-par providers essential to the adequacy requirements for these multiple networks.
· Participates in the development and maintenance of legal contract templates and amendments and obtain appropriate and timely signoff from compliance, legal, regulatory and other stakeholders.
· Maintains awareness of and acts in accordance with internal and external compliance and regulatory requirements, including but not limited to NYS DOH, NYS DFS, and CMS.
· Works collaboratively with internal stakeholders, including clinical, sales, quality, line of business and other departments to ensure a solid understanding of initiatives. Develops and implements strategies to secure appropriate and prioritized stakeholder needs.
· Develops and maintains strong knowledge of Plan products & offerings; Plan and BCBSA strategies and objectives; and industry trends. Leverages this knowledge skillfully in planning and negotiations. Able to advance Plan needs and strategies effectively and positively with providers and other stakeholders.
· Works with other internal areas in developing best practice principles around contract negotiations and reimbursement.
· Identifies opportunities for reducing benefit expense.
· Accountable for the impact of provider contracts on pricing points for all products and will act as a liaison with Utilization Management, Care Management and Actuarial/finance to ensure appropriate strategies are developed and implemented relative to benefit expense management.
· Provides clear feedback to provider relations and communications to ensure provider relations and communications plan are effective in addressing provider issues and needs.
· Maintains and enhances a strong relationship with providers, while balancing the need to maintain competitive pricing position through effective negotiations.
· Presents an effective and positive image of the Health Plan and its leadership by promoting Health Plans community initiatives and not for profit goals.
· Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.
· Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
· Maintains knowledge of all relevant legislative and regulatory mandates and ensures that all activities are in compliance with these requirements.
· Conducts periodic staff meetings to include timely distribution and education related to departmental and Ethics/Compliance information.
· Regular and reliable attendance is expected and required.
· Performs other duties and functions as assigned by management.
Minimum Qualifications:
· Bachelor's degree or equivalent experience in Health Care Administration, Finance, Public Administration or relevant field required. Master's degree or equivalent experience in Health Care Administration, Finance, Public Administration, or relevant field preferred.
· Strong & demonstrated experience in finance, actuarial, negotiations or other relevant disciplines.
· Five to seven years in health care experience involved in reimbursement, finance, contract negotiations, or related experience with hospitals and providers. Experience in finance, actuarial, and provider relations is preferred.
· Four years leadership/management experience.
· Excellent communication, presentation, problem solving and negotiation skills.
· Must be able to work constructively with external contacts including hospital administrators, owners of provider companies, physicians, provider organization leaders, and other providers of health and health related services and equipment.
· Demonstrated understanding of current industry trends including healthcare operations, insurance products, and provider entities. Experience with reimbursement methodologies (private and governmental) and ability to understand and utilize financial models. Able to knowledgably and effectively discuss these issues with others.
· Advanced understanding of Health Plan's strategies and initiatives, able to identify and manage dependencies, and able to articulate and influence adoption of those appropriate to providers.
Physical Requirements:
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The Lifetime Healthcare Companies aims to attract the best talent from diverse socioeconomic, cultural and experiential backgrounds, to diversify our workforce and best reflect the communities we serve.
Our mission is to foster an environment where diversity and inclusion are explicitly recognized as fundamental parts of our organizational culture. We believe that diversity of thought and background drives innovation which enables us to provide leading-edge healthcare insurance and services. With that mission in mind, we recruit the best candidates from all communities, to diversify and strengthen our workforce.
OUR COMPANY CULTURE:
Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation and having fun! We aim to be an employer of choice by valuing workforce diversity, innovative thinking, employee development, and by offering competitive compensation and benefits.
In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.
Equal Opportunity Employer
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)
Manager