Provider Medicaid Contracts Manager (Remote Option)

Competitive Compensation & Benefits Package!

Position eligible for -
? Annual incentive bonus plan
? Medical, dental, and vision insurance with low deductible/low cost health plan
? Generous vacation and sick time accrual
? 12 paid holidays
? State Retirement (pension plan)
? 401(k) Plan with employer match
? Company paid life and disability insurance
? Wellness Programs

See attachment for additional details.

Office Location: Flexible for any of our office locations; Remote Option Available

Projected Hiring Range: Depending on Experience
Closing Date: Open Until Filled

Primary Purpose of Position:

This position will provide management and oversight of the Medicaid Contract Unit. Work involves data entry and analysis, data mining, data management, reporting, record keeping, and providing, managing and coordinating the provision of a full range of support activities necessary for the effective management of contracting data for the department.

Role and Responsibilities: ? The Contract Manager is responsible for all duties related to managing payor contracts, negotiation and renegotiation of new and existing payor contracts ? This position works closely with members of the Provider Enrollment and Maintenance team to ensure contracts are appropriately identified, negotiated, implemented, audited and renegotiated in a timely manner ? This position requires prior knowledge of Managed Care in a Provider or Payor setting in addition to understanding of Payer Contracting tasks and activities ? Proficient in the development, coordination and analysis of payor contracts ? Responsible for efficiently and effectively negotiating payment terms and rates for new and existing contracts that are favorable for the organization ? Proficient in the review of contract terms and conditions in order to facilitate accurate implementation of contracts ? Responsible for the maintenance of contract templates and approvals from NCDHHS to ensure compliance with the Tailored Plan and Medicaid Direct Contract requirements. ? Proficient in monitoring renewals of contacts as assigned and renegotiating contract rates and terms as appropriate upon renewal ? Resolve escalated contract specific issues ? Supervision and coaching of Contracts staff in complex, time-sensitive regulatory matters. ? Evaluate, understand, and negotiate provider contracts in compliance with company templates, reimbursement structure standards and other key process controls ? Influence and/or provide input to forecasting and planning activities for network growth ? Manage performance target setting, performance reporting and associated financial models relative to provider network contracting ? Establish and maintain strong business relationships with assigned providers and internal partners ? Design reports for internal and external recipients, which may require independent research. ? Work with internal departments to compile and analyze contract data and documentation for audit review & quality improvement. ? Produce and examine reports, gather and coordinate submission of State reports as mandated). Respond to requests from other Partners staff, particularly concerning provider status. ? Receive, review, analyze, track and maintain timely records of time sensitive and confidential information. ? Responsible for accurate and timely maintenance of provider information essential to Partners ability to accurately track network provider contracts; process authorizations and claims; and produce an accurate provider directory. It is critical that the staff person in this position be accurate and thorough in the completion of their duties. ? Failure to input accurate and complete information has the potential to negatively impact the service delivery system and consumer ability to access services in a timely manner. ? Participates in on-going quality improvement activities with other departments including UM, Claims, Care Coordination and IT.

Knowledge, Skills and Abilities:
? Strong, working knowledge of data extraction methodologies
? Ability to exercise appropriate judgement and discretion in presenting data
? Ability to present complex data and information to varying audiences, both internal and external, in a professional and clear manner.
? Knowledge of program practices, techniques, and technology sufficient to support the program
? Knowledge of the goals and objectives of the work unit and an understanding of the structure and functions of the organization (must have knowledge of staff assignments/commitments, and the functions of other internal and external organizational segments whose work impacts on the unit or with which work must be interfaced)
? Excellent computer skills; proficient in Microsoft Office Products (Word, Excel, Outlook, Publisher); experience in use of databases
? Ability to practice effective communication techniques, oral and written
? Ability to establish and maintain effective interpersonal and working relationships with internal and external customers
? Ability to analyze and interpret policy and procedural guidelines and to resolve problems and questions, independently
? Ability to complete non-routine activities and tasks that require deviation from established procedures which includes the ability to choose the appropriate course of action and recognize the existence of and differences among situations
? Ability to use initiative and judgment in resolving problems not covered by established priorities or prior experience
? Ability to recognize sensitive or unusual situations that should be referred to another more appropriate staff member or to the supervisor
? Ability to manage and uphold integrity and confidentiality of sensitive data

Education/Experience Required:

Undergraduate degree or three years Network management-related work experience. At least three years of experience in a network management-related role handling complex network providers with accountability for business results. At least three years of experience with direct provider contracting, including facility, physician, and ancillary providers. Experience with client-facing responsibilities, including issue resolution and contract negotiations.

Other Requirement: Must reside in North Carolina or within 40 miles of the NC border.

Education and Experience Preferred:

Paralegal background preferred. At least five years of experience with direct provider contracting, including facility, physician, and ancillary. Experience in healthcare, especially public behavioral health, managed Medicaid, and healthcare payor systems and law.