New

Provider Contracting Manager

TEKsystems
$38.46 - $43.27 / hr
life insurance, sick time, 401(k), retirement plan
United States, Hawaii, Honolulu
Feb 22, 2025
Healthcare: Provider Contracting Analyst Full-time, hybrid work environment Must live on Oahu, Hawaii 6 months contract to Hire Description Aligned with the overall corporate mission, vision, values, and strategy, you are responsible for informing, supporting, and shaping the company's strategy and initiatives as to its providers, with a specific focus on negotiated arrangements for medical groups, facilities, and hospitals. You are specifically responsible for (1) developing, reviewing, and evaluating financial proposals related to contract negotiations with providers and (2) preparing, examining, analyzing, negotiating, and revising provider contracts and negotiated arrangements. You serve as the principal point of contact for facilities and providers, primarily focusing on financial and contractual matters and facilitating resolution for other provider matters in accordance with corporate strategy. You are responsible for building partnerships and maintaining positive relationships with facilities and providers through frequent site visits, communication, negotiations, and active and responsive service to the provider's needs and requests. Provider Strategy Will be responsible for actively shaping, informing, leading, and implementing the company's overall corporate strategy to its providers. Expected to play an integral role in supporting, including implementing, various strategic provider initiatives and working closely with other Departments, including the Office of Payment Transformation, Finance and Accounting, Medical Management, Medicare and Medicaid Programs, IHMS, and Market and Product Strategy to coordinate and implement strategic provider initiatives. These responsibilities include, but are not limited to, the following: Financial Strategy - Aligned with mission, vision, values, and provider strategy, develop, shape, and evaluate financial proposals negotiated with providers, including value-based payment, the company's Advanced Hospital Care program, or other alternative payment models. Work closely with leadership, Finance and Accounting, Quality Management, Provider Operations, Medical Management, Office of Payment Transformation, and Corporate Analytics departments to develop and/or evaluate financial proposals. Negotiate financial proposals directly with providers. Negotiate Contracts - Negotiate standard and nonstandard agreements with providers by working closely with Legal, Business Integrity, Provider Operations, Finance and Accounting, Credentialing, Office of Payment Transformation, and other departments to ensure that the arrangement reached with each provider is driving provider strategy balanced with mitigating corporate legal, regulatory and operational risks. This includes reviewing and evaluating redlined contracts, making language recommendations, negotiating directly with providers and their agents, and being responsible for the overall negotiated arrangement with the provider. Monitor and manage the disbursement of funds for contract obligations for non-claims expenses. This includes programs/projects like strategic community investment funds, recruiting programs, and bonuses for quality or volume. Evaluate and communicate with executives and interested departments regarding program effectiveness. 50% Relationship Management: Provider Partnering - Develop close partnerships with providers to (1) lead and drive the company's mission, vision, values, and provider strategy and (2) facilitate strategic contracting with providers. Monitor and evaluate status of company's relationship with providers to better inform provider and contracting strategy. Responsible for identifying and coordinating, among internal and external stakeholders, the resolution of provider issues. Internal Partnering - Develop close partnerships with various departments to continuously develop and improve the company's provider strategy. At a detailed level, coordinate provider contractual requirements to ensure appropriate implantation and administration of provider contracts and negotiated arrangements. This includes but is not limited to (1) working with Finance and Accounting to ensure adherence to broader financial requirements, including revenue recognition, pricing, and discounting policies; (2) understanding and evaluating the financial impact of provider proposals, and working closely with Finance and Accounting to implement contractual requirements, and (3) working with departments focused on operational, regulatory, and clinical outcomes to ensure provider contracts meet requirements and render appropriate, quality, and affordable care to members. Internal Operations Maintain contractual records and documentation such as receipt and control of all contract correspondence, customer contact information, contractual changes, status reports, and other documents for all projects. Ensure signed contracts are communicated to all relevant parties to provide contract visibility awareness and interpretation to support implementation. Ensure all parties comply with contract terms. Ensure contract close-out, extension, or renewal. Develop and implement contract management and administration procedures to comply with company policy and mitigate risk to the company. As appropriate, contribute to or influence company policies. Develop and prepare regular reports on the status of contracts and negotiations based on detailed analysis. Other duties as assigned As needed, work directly on corporate initiatives, including strategic provider initiatives, and provide guidance on contract matters to supervisors or other operational staff, including training new project stakeholders and other employees in contracting practices and procedures. Performs all other miscellaneous responsibilities and duties as assigned or directed. Skills negotiation skills, account management, provider relations, provider service, contract negotiation Additional Skills & Qualifications * Bachelor's degree and five years of contract preparation/administration, financial management and/or related work experience; or equivalent combination of education and related work experience. * Experience with a highly regulated industry. * Experience negotiating contracts and/or vendor/contract management. * Communicate clearly and concisely, both verbally and in writing. * Establish and maintain effective working relationships with those contacted in the course of work. * Excellent interpersonal skills. * Strong analytical skills. * Strong planning and organization skills. * Excellent leadership skills. * Good working knowledge of Microsoft Office applications Pay and Benefits The pay range for this position is $38.46 - $43.27/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: * Medical, dental & vision * Critical Illness, Accident, and Hospital * 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available * Life Insurance (Voluntary Life & AD&D for the employee and dependents) * Short and long-term disability * Health Spending Account (HSA) * Transportation benefits * Employee Assistance Program * Time Off/Leave (PTO, Vacation or Sick Leave) Workplace Type This is a hybrid position in Honolulu,HI. Application Deadline This position is anticipated to close on Mar 7, 2025. About TEKsystems: We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.