Contracts Manager, Payor

Altais

2d•$107,250 - $128,700

About The Position

At Altais, we’re on a mission to improve the healthcare experience for everyone—starting with the people who deliver it. We believe physicians should spend more time with patients and less time on administrative tasks. Through smarter technology, purpose-built tools, and a team-based model of care, we help doctors do what they do best: care for people. Altais includes a network of physician-led organizations across California, including Brown & Toland Physicians, Altais Medical Group Riverside, and Family Care Specialists. Together, we’re building a stronger, more connected healthcare system. About the Role Are you looking to join a fast-growing, dynamic team? We’re a collaborative, purpose-driven group that’s passionate about transforming healthcare from the inside out. At Altais, we support one another, adapt quickly, and work with integrity as we build a better experience for physicians and their patients. The Contracts Manager, Payor is responsible for managing and negotiating Payor Contracts for all lines of business; Commercial, Medicare and Medi-Caid HMO, PPO, and ACO. Primary duties include health plan operations, contract analyses, negotiations and contributing to operational implementation.

Requirements

Minimum of five (5) years of managed healthcare contracting and health plan negotiating experience necessary to have acquired and demonstrated skills and abilities listed above.
At least three (3) years working for a health plan or medical group/IPA in the Payor space.
College degree or equivalent experience

Responsibilities

Responsible for the management of multiple health plan contracts with various risk sharing and delegation arrangements for the state of California.
Effectively conducts negotiations with health plan and payor partners to achieve operational efficiency and budgeted results on a timely basis with moderate supervision:
Conducts review of historical/potential financial performance of the contracts, using MLR financial reports and previous negotiation history.
Prepares negotiation letters and sends them out in a timely manner to begin negotiations.
Tracks negotiation history and creates rate comparison grids and other resources to show negotiation progress.
Researches the effect of contract and financial terms with operating departments.
Work with other departments to ensure operational concerns are addressed in new contracts.
Submit financial analysis requests to Finance for health plan contract negotiations and act as point person for questions.
Ensures contract language abides by state and federal law and community standard. Any deviations from language must be signed off by the appropriate department lead and/or Legal.
Drafts and implements accurate and timely written communication pieces regarding new and renewed health plan payer arrangements and to the network and appropriate departments, including:
Tracks all negotiations for Senior Executives and Board of Director Summaries.
Update Health Plan presentation deck with contract negotiation status for executive leader meetings.
Communicates results of the finalized arrangement for presentation to internal departments as appropriate, i.e. some redacted versions.
Solicits information and feedback from operating departments regarding, implementation and performance of contracts as required.
Maintains all health plan payer contract data in a Health Plan Contract Summary grid or contract management database with reportable functionality.
Review and update health plan renewal tracking grid for all health plan contracts.
Develop and maintain successful relationships with Health Plan Payer partners and maintain a contact list of all levels of health plan payer partner Contracting staff.
Act as liaison for resolution of problems related to the operations of all health plan contracts.
Maintain organization of health plan payer resources on BTNet, i.e. Provider Manuals, Contact List, Communication Notices, DOFR’s, etc.
Support Provider Contract negotiations, as necessary.
Conducts organizational in-service/education of organization on health plan payer relationship and contract terms.
Performs all office functions accurately within reasonable limits based upon established needs and specified deadlines.
Collaborate with operational leaders to reach mutually agreeable health plan contract language and ensure compliance with contract terms.
Contract language interpretation and delegation knowledge and skills in multiple lines of business (i.e. HMO, PPO, ACO, MSSP).
Responsible for training, educating, assisting, and solving escalated issues related to contract terms and operations company-wide.