Contract Manager - Health Insurance

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Located in Bend, OR

Salary: Competitive comp & benefits!

Be a part of dynamic team that is making an impact in the Central Oregon healthcare community and beyond!

 

What You Get to Do!

This position is responsible for administering and managing the organization’s current contracts with health plan partners, development of additional contract partners, and will provide contract oversight and review to Management (Chief Executive Officer, Chief Medical Director, etc.).

 

This position is also responsible for enhancing our contract revenue stream by analyzing contract opportunities to increase or maintain appropriate partners and develop strategies for developing additional lines of business and relationships.

 

This role will also build and maintain relationships with internal and external sources involved in the contracting process by supporting the CEO during contract negotiations and assist with the development of contract language and negotiation strategy.  This role will also work closely with the Finance Department and Population Health team on implementation of contracts and compliance with contract terms to ensure rules and requirements are being followed and to support the renegotiation process.

  • Analyze contracts to achieve strategic contracting goals:
  • Develop strategy for contract relationships, including specific lines of business (i.e., Medicare Advantage, Medicaid, and commercial lines of business).
  • Respond to market opportunities and monitor significant market changes.
  • Support CEO when meeting with health plans and payers for proposals and counterproposals, negotiation of rates and language, including development of key agenda items and preparation for negotiation, as well as occasionally lead the meetings and negotiate key topics.
  • Work with Population Health Team to analyze significant and unique contract requirements, develop measurable quality improvement metrics and special provisions, terms, and conditions to ensure compliance with appropriate laws, regulations, and business procedures.
  • Ensure language, term, and conditions meets the strategic goals of the organizaition’s Ends.
  • Analyze the significance and value of potential contracts; determine the cost of care based on care delivery and contract structure. Project contract performance based on modeling of actual and representative samples.
  • Monitor contract performance and other provisions to ensure compliance, identify problem areas, and resolve disputes as they arise.
  • Responsible for ongoing analysis of existing contracts and new contract opportunities:
  • Develop standard reports and any required ad hoc reporting.
  • Assist with reporting needs for budget purposes, revenue projections, and long-range planning.
  • Routinely monitor member lives per line of business for discrepancies in enrollment numbers.
  • Update CEO on unexpected changes in the planned performance of contracts.
  • Serve as a liaison between organizational departments regarding ongoing contract compliance to support the organization’s Ends:
  • Address operational issues with health plan partners by proactively identifying issues and soliciting information from the Finance Department regarding implementation and performance of contracts.
  • Determine how Contracting Department can assist with processes, communication, or interpretation of contract language.
  • Be knowledgeable and available as a resource for staff for issues and concerns and to contribute to continual contract improvement for the organization’s members.
  • Participate in committees and related work groups as needed.
  • Attend team meetings and participate in discussions and strategic initiatives.

 

What You Will Need:

  • Bachelor of Arts/Sciences in Business, Finance, Healthcare Administration or related field preferred.
  • Five or more years of experience in a similar function, e.g. revenue cycle manager.
  • Excellent written and oral communication skills
  • Strong critical thinking and problem-solving skills
  • Ability to work independently with minimal supervision
  • Proficiency in Microsoft Office Applications – Excel, PowerPoint, Word, Outlook
  • Exhibit strong organizational skills
  • To be self-directed
  • Able to prioritize and meet deadlines
  • Take on projects, develop and carry out efficiently
  • Ask questions or research topics and/or issues that are unfamiliar

 

To Apply: For confidential consideration, please submit resume to karen.turner@expresspros.com

Express Office: Bend
61379 South Highway 97
Bend, OR 97702
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