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Payor Contract Manager

Payor Contract Manager

MaineHealthPortland, ME, United States
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Description

The Contract Manager is responsible for the development, implementation and ongoing management of commercial fee for service and value-based payer contracts across MaineHealth, and the MaineHealth Accountable Care Organization (MHACO). This role is critical in supporting optimal reimbursement, maintaining the System's competitive position, and fostering strong relationships with payer organizations. The Contract Manager will work collaboratively with internal stakeholders and external partners to support the financial and operational objectives of the System and its affiliates as it relates to Payer Relations activities.

Primary Responsibilities :

Contract Strategy & Negotiations :

  • Negotiate contractual and reimbursement terms with market payers for all services rendered by MaineHealth entities.
  • Negotiate value-based agreements with payers on behalf of MHACO.
  • Amend existing agreements to include services not currently under contract and / or new services, facilities, etc.
  • Participate in system strategic initiatives impacting selectpayers, as needed
  • Create and maintain a checklist of required elements for contract language in collaboration with MH Legal
  • Inform and assist in pricing strategies to maintain MH's competitiveness in the regional marketplace in order to generate appropriate margins.

Performance Management & Maintenance :

  • Provide support and guidance to RCM leadership to monitor and report financial performance of assigned payer contracts versus expectations to assure achievement of negotiated rates. Recommend necessary actions to management based on contract performance.
  • Identify and develop strategies to mitigate risks and sources of exposure in payer contracts.
  • Work closely with RCM on operational issues that become contract issues, including attendance at payer Joint Operating Committee (JOC) meetings.
  • Assure routine audits of payer data are performed to ensure compliance with contracted payment terms.
  • Proactively work with Decision Support to report and refine the reporting of contract performance, analysis, and modeling tools.
  • Prepare reports for committees and the boards as required

    • Stakeholder Engagement :

  • Establish and maintain relationships with payers and serve as a point of contact for all aspects of the relationship
  • Establish, promote, and maintain relationships throughout the MaineHealth System in support of payer relations objectives.
  • Field questions and provide answers or ensure appropriate staff follow up effectively.
  • Provide education on new agreements as they affect stakeholders via written communications or presentations as needed. Anticipate and address hospital CFO needs for information resulting from new or modified agreements.
  • Contribute to communications and education to the System utilizing the electronic newsletter, website, and educational sessions as needed.
  • Attend conferences, participate in professional organizations, and / or read publications to update knowledge of trends and product development in the field
  • Develop and maintain ongoing interactions with appropriate staff and management at member organizations regarding payer contracting in conjunction with the Director of Contracting and Network Development.
  • Interact with providers to identify payer trends requiring action or escalation
  • Work with other internal partners on supporting / leading select system strategies where Contracting can drive specific change or help develop new processes

    • Compliance & Market Research :

  • Facilitate the approval and signature process for contracts, single case agreements and settlements.
  • Create and implement, based on Management feedback and information supplied by other System entities, payer contracting processes and procedures to maximize System performance in payer relationships.
  • Leverage transparency data to assure negotiated rates and rate requests are competitive
  • Stay informed of product developments and market pricing at competitor medical centers in an effort to support successful negotiations

    • Other Responsibilities :

  • Respond creatively and effectively to special projects assigned by the CFO, Vice President, and Director.
  • Assist in the development of departmental goals, execute projects to achieve these goals, and work closely with others within the organization to continuously monitor department performance.
  • Act in a caring and courteous manner towards all patients, guests, visitors, students, and staff

    • Required Minimum Knowledge, Skills, and Abilities (KSAs

  • Bachelor's degree in Business Administration, Healthcare Administration, Finance, or a related field preferred.
  • Minimum 5 years of experience in managed care contracting, provider relations, or payer relations within a hospital system, physician organization, or health plan.
  • Strong understanding of healthcare reimbursement methodologies (e.g., DRG, APC, fee-for-service, value-based care).
  • Demonstrated experience in negotiating and managing complex payer contracts.
  • Excellent analytical and problem-solving skills with the ability to interpret and present financial and operational data.
  • Proficiency in using Microsoft Office and Adobe Acrobat products.
  • Strong interpersonal, communication (written and verbal), and presentation skills.
  • Ability to build and maintain effective working relationships with internal and external stakeholders.
  • Knowledge of relevant healthcare laws, regulations, and industry trends.
  • Ability to work independently and as part of a team.
  • Strong organizational and time management skills with the ability to prioritize tasks and meet deadlines.
  • Additional Information

    • With a career at any of the MaineHealth locations across Maine and New Hampshire, you'll be working with health care professionals that truly value the people around them - both within the walls of the organization and the communities that surround it.

    We offer benefits that support an individual's needs for today and flexibility to plan for tomorrow - programs such as paid parental leave, a flexible work policy, student loan assistance, training and education, along with well-being resources for you and your family.

    MaineHealth remains focused on investing in our care team and developing an inclusive environment where you can thrive and feel supported to realize your full potential. If you're looking to build a career in a place where people help one another deliver best-in-class care, apply today.

    If you have questions about this role, please contact leanne.roberts@mainehealth.org

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