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Jefferson Health · 2 days ago

Network Contracting Manager - JHP

Philadelphia, PA

Full-time

Hybrid

Mid, Senior Level

5+ years exp

Jefferson Health is a nationally ranked health care system dedicated to providing high-quality clinical care and education. They are seeking a Network Contracting Manager to negotiate hospital and health system agreements, develop contracts, and promote value-based reimbursement components to enhance provider networks.

Hospital & Health Care

Responsibilities

Leads or assists with assigned negotiations for hospital/health system contracts (i.e., hospital, physician, and ancillary) and ensures that negotiations meet the company's strategic and financial goals and objectives

Manage the negotiation of rates and language terms for existing and new physicians, ancillary, hospital/health systems, and other related provider agreements

Prepares contracts, contract amendments, rate proposals, and rate analyses

Facilitates and provides oversight for provider setup and contract configuration to ensure accurate system setup, fee schedule development, and accurate claims adjudication

Work with HPP management, other appropriate staff, and health systems to explore, develop, and implement innovative, value-based approaches to contracting

Coordinates with internal departments and contracted providers to implement and maintain contract compliance. Recommends operational changes or process improvements to appropriate stakeholders as required

Act as subject matter expert regarding physician, ancillary hospital, and health system contracts, and interpret and resolve business questions from network providers and internal customers

Recruit providers to meet network adequacy and marketability needs in alignment with health plan goals

Ensures that, during negotiations, contracts meet all regulatory requirements

Describes contract changes to other departments and reviews existing provider agreements to determine the need for creating new exhibits and amendments based on regulatory changes

Maintain and foster collaborative relationships with provider executives and internal and external customers

Develop and maintain monitoring tools for negotiated agreements

Performs job duties in compliance with applicable policies and procedures

He remains informed of industry trends related to physician, ancillary, hospital, and provider contracting and advises senior management of trends and issues that impact JHP

Serve as departmental representative/participant on interdepartmental and external work groups/task forces as assigned

May perform other duties as assigned

Qualification

Hospital contracting experienceProvider reimbursement methodologiesValue-based reimbursementProvider recruitmentQuantitative analytic abilitiesMicrosoft ExcelWritten communicationOral communicationAttention to detailOrganizational skills

Required

Relevant bachelor's degree and/or 5-7 years equivalent combination of work experience

3-5 years of hospital or ancillary contracting experience in a managed care setting (payer or provider based)

Strong knowledge of hospital and provider reimbursement methodologies

3-5 years' experience with Medicare, Medicaid, and value-based reimbursement methodologies preferred

5-7 years' Experience with provider recruitment, customer service and claims payment

In-depth knowledge of the managed care industry and practices, as well as a strong understanding of competitor strategies, practices, and financial/contracting arrangements

Excel at maintaining positive working relationships internally and externally

Superior organization and follow-up skills

Excellent written and oral communication skills

Strong quantitative analytic abilities

Careful attention to detail

Ability to represent Health Partners independently with external providers

Intermediate knowledge required of Microsoft Excel, Word, and PowerPoint

Knowledge of provider payment methodologies for Medicaid, Medicare and Commercial lines of business

Preferred

3-5 years' experience with Medicare, Medicaid, and value-based reimbursement methodologies preferred

Advanced knowledge of Microsoft Excel, Word, and PowerPoint preferred

Benefits

Medical (including prescription)

Supplemental insurance

Dental

Vision

Life and AD&D insurance

Short- and long-term disability

Flexible spending accounts

Retirement plans

Tuition assistance

Voluntary benefits

Company

Jefferson Health

Thomas Jefferson University and Thomas Jefferson University Hospitals are partners in providing excellent clinical and compassionate care for our patients in the Philadelphia region, educating the health professionals of tomorrow in a variety of disciplines and discovering new knowledge that will define the future of clinical care.

Founded in 1995

Philadelphia, PA, US

5001-10000 employees