Managed Care (Payor) Contract Negotiator

Job Description

Job Overview :

The Managed Care (Payor) Contract Negotiator is an integral member of the Managed Care team. A successful candidate is an experienced and knowledgeable negotiator of Managed Care contracts and contractual interpretations for healthcare payment and benefit issues. The Managed Care Negotiator will be responsible for identifying, developing, and maintaining an effective relationship with contracted payors, health plans, and managed care entities. This role requires the ability to actively draft and negotiate Managed Care contracts incorporating knowledge and input from the health system's care operations and administrative and financial areas. The Contract Negotiator must be knowledgeable about the Managed Care environment;  including delegated arrangements; Payor Networks : PPO, HMO, IPA, POS; and, value-based contracting. The Contract Negotiator should have a working knowledge of  CPT-4, HCPCS, Revenue and ICD coding, medical terminology, claims payment, contract negotiations, and problem resolution.  The candidate must possess the ability to work collaboratively in a team setting. The Contract Negotiator will have experience in successfully operationalizing Managed Care contracts in a health system. The Contract Negotiator is an effective communicator at all organizational levels and in situations requiring instructing, persuading, negotiating, consulting, and advising. The successful candidate is comfortable leading in-person and video meetings in front of any group size, and staff and management level. The Contract Negotiator must be able to maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA) and possess the ability to deal responsibly with confidential matters.  The Contract Negotiator monitors political, legal, and regulatory trends with respect to Managed Care and updates Manager / Director accordingly. The successful candidate must be able to prioritize, plan, and handle multiple tasks / demands simultaneously. The Contract Negotiator is someone with excellent verbal and written communication skills, as well as excellent critical thinking skills. The candidate must be self-motivated with keen attention to detail who is excited about joining a collaborative team driving big impact on TriHealth and those that we serve.

Job Requirements :

Bachelor's Degree in Health Care Administration; Health Policy; Law; Public Health; Business Administration

Equivalent experience accepted in lieu of degree

Excel, Word, and Power Point proficiency, familiar with data technology

3-4 years experience Contracting

Managed Care

Health Care Administration; Health Policy; Law; Public Health; Business Administration

3 - 4 years

Job Responsibilities :

Serves as a first line Managed Care Contract Negotiator for health system and is responsible for assigned Managed Care contracts, payors, and payor types. This role is under the direction of the Manager of Managed Care Operations.  The role requires the ability and knowledge to evaluate, negotiate, and secure financially and administratively favorable contracts with new and existing payors.

Assists with all aspects of Managed Care operations including contract negotiation, request and review of contract payment modeling, and contract implementation. Supports cross-functional teams with demonstrated understanding of Managed Care contract language, terms, and reimbursement methodologies.

Functions as an effective liaison between the health system and payors for Managed Care operational issues. Communicates effectively at all organizational levels

Must be able to prioritize, plan, and handle multiple tasks / demands simultaneously and be flexible, be readily adaptable, and work in a rapidly and constantly changing environment.

Acts as a liaison between health system and other internal and external entities to create seamless operational Managed Care performance along with maximizing payor contracting terms. Ensures negotiations are handled efficiently to meet important deadlines and remain within approved financial parameters.

Adheres to the mission, vision, and values of TriHealth.

Other Job-Related Information :

Working Conditions :

Climbing - Rarely

Concentrating - Consistently

Continuous Learning - Frequently

Hearing : Conversation - Frequently

Interpersonal Communication - Consistently

Kneeling - Rarely

Lifting

Lifting 50+ Lbs - Rarely

Lifting 11-50 Lbs - Rarely

Pulling - Rarely

Pushing - Rarely

Reaching - Rarely

Reading - Consistently

Sitting - Consistently

Standing - Occasionally

Stooping - Rarely

Talking - Frequently

Thinking / Reasoning - Consistently

Use of Hands - Consistently

Color Vision - Rarely

Visual Acuity : Far - Frequently

Visual Acuity : Near - Frequently

Walking - Consistently

TriHealth SERVE Standards and ALWAYS Behaviors

At TriHealth, we believe there is no responsibility more important than to SERVE our patients, our communities, and our fellow team members. To achieve our vision and mission, ALL TriHealth team members are expected to demonstrate and live the following :

Serve : ALWAYS…

• Welcome everyone by making eye contact, greeting with a smile, and saying "hello"
• Acknowledge when patients / guests are lost and escort them to their destination or find someone who can assist
• Refrain from using cell phones for personal reasons in public spaces or patient care areas

Excel : ALWAYS…

Respect : ALWAYS…

Value : ALWAYS…

Engage : ALWAYS…