Why Choose Health Partners Plans?

Health Partners Plans is an award-winning, not-for-profit health maintenance organization serving more than 280,000 members for more than 30 years. Health Partners Plans has been doing it right and improving health and wellness in communities throughout the Greater Southeastern Pennsylvania region.

Perks of HPP and why you will love it here:

* Competitive Compensation Packages including 401(k) Savings Plan with Company Match and Profit Sharing
* Flextime and Work-at-Home Options
* Benefits & Wellness Program including generous Time Off
* Diversity & Inclusion commitment
* Impact on the communities we service

We are hiring a Provider Contracting Manager to join our team remotely!

Working under the direction of the Director or designee, with minimal supervision, negotiates and assists in negotiating provider network agreements, including physician, hospital and ancillary agreements, in building and maintaining high-quality and cost-effective provider networks to meet and exceed regulatory and organizational goals. Develops and maintains written contracts and performs analysis for providers for both reimbursement rates and contract language, as required, on a timely basis. Promotes value-based reimbursement components within hospital and system agreements as directed. Works with departments across the organization to develop support and approval for network contracting activities.

As the Provider Contracting Manager your daily duties may include…

* Leads or assists with assigned negotiation for provider network contracts (i.e., hospital, physician and ancillary) and ensures that negotiations meet the strategic and financial goals and objectives of the company.
* Manage the negotiation of rates and language terms primarily for existing and new expansion physician, ancillary, hospital/health systems, and other related provider agreements for existing and new providers
* Prepares contracts, contract amendments, rate proposals and rate analyses.
* Maintain hospital payment grid for internal use by other departments including Utilization Management, Claims and Finance.
* Calculates scheduled hospital rate increases, obtain provider concurrence, and implement changes with other departments.
* Facilitates and provides oversight for provider set-up and contract configuration to ensure accurate system set up, 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 on physician, ancillary and hospital and health system contracts and field business unit questions and concerns as needed.
* Recruits providers on an on-going basis to meet network adequacy and marketability needs in alignment with health plan goals. Ensures that, during negotiations, contracts meet all regulatory requirements by engaging internal compliance when needed.
* Describes contract changes to other departments and review existing provider agreements to determine the need for creating new exhibits and/or amendments, based upon regulatory changes. Manage contract renewal process for existing facilities to ensure timely re-negotiation
* .Maintain and foster collaborative relationships with ancillary and hospital and health system executives and other internal and external customers.
* Develop and maintain monitoring tools for negotiated agreements
* Performs job duties in compliance with policies and procedures of Network Management and Health Partners Plans.
* Remains informed of industry trends related to physician, ancillary and hospital and provider contracting and advise senior management of trends and issues that impact HPP.
* Serve as departmental representative/participant on interdepartmental and external work groups/task forces as assigned.
* May perform other duties as assigned.

Qualifications and Skills, We Value

* Relevant Bachelor's Degree and/or 6-10 years equivalent combination of work experience.
* 6-10 years of professional, hospital or ancillary contracting and recruitment experience in a managed care setting (payer or provider based).
* Strong knowledge of provider reimbursement methodologies, provider contract terms and conditions, and reimbursement analytics.
* 6-10 years' experience with Medicare Advantage and Medicaid,.
* 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 to advanced use of Microsoft Excel and Word. Knowledge of Microsoft Access desirable.
* Knowledge of provider payment methodologies, sufficient to analyze cost experience.

HPP is a nationally recognized company for our innovations in care. We are more than your average health care company and can help you achieve your career goals!

Other details

* Pay Type Salary
* Travel Required No
* Required Education Bachelor's Degree

Apply Now

* Philadelphia, PA, USA