Senior Contract Manager Ancillary Network Contracting

Point32Health • Canton, MA

1d

About The Position

Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. We’ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it’s at the core of who we are. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work. We enjoy the important work we do every day in service to our members, partners, colleagues and communities. Learn more about who we are at Point32Health . Job Summary The Senior Contract Manager, Ancillary Network Contracting, will be part of the Point32Health Ancillary Network Contracting team reporting to the Manager, Ancillary Network Contracting. Senior Contract Manager will operate with minimal oversite to manage ancillary specialties, for Harvard Pilgrim and Tufts Health networks for all lines of business. The Senior Contract Manager is responsible for provider specialties that are more complex in reimbursement, benefit application, and/or larger networks. The Senior Contract Manager will function as point person for provider recruitments; determining network needs and evaluating prospective providers. The Senior Contract Manager will be responsible for working on contract negotiation and administration; adhering to plan reimbursement strategies. This individual will ensure that contract terms are consistent with the organization’s established legal and financial guidelines. Additionally, the Senior Contract Manager will serve as a mentor; acting as a resource and assisting with training other team members. The Sr. Contract Manager will participate and will contribute to cross-divisional projects to ensure compliance and will collaborate on operational improvements and consistencies both internally and externally.

Responsibilities

• Develops, negotiates, executes and manages provider contracts for services and reimbursement issues with ancillary providers.
• Participates in all operational aspects of contractual agreements.
• Develops and maintains key provider relationships.
• Effectively manages the enterprise contractual structure with providers across networks and lines of business. As well as represent the ancillary providers within the organization to include key network issues relevant to plan strategy and operations.
• Collaborates with analytic staff to develop medical budget, evaluate cost trends, and formulate reimbursement models and/or program design.
• Monitors marketplace trends and new reimbursement methodologies.
• Is well versed in publicly reported data on reimbursement, market competitors, and regulatory requirements.
• Evaluates the demand for assigned services and identifies areas of network deficiencies or increased service demand for network expansion.
• Determines the unique service capabilities of providers in the network.
• Designs and implements tools for communicating these capabilities to other departments and membership.
• Identifies, evaluates, and implements new programs for improving medical cost management and/or administrative efficiency.
• Represents Ancillary Network Contracting team in internal and external meetings.
• Prepares and delivers presentations with providers and to partner departments.
• Maintains industry-specific knowledge and relationships with key providers and industry groups
• Other duties and projects as assigned.

Benefits

• Medical, dental and vision coverage
• Retirement plans
• Paid time off
• Employer-paid life and disability insurance with additional buy-up coverage options
• Tuition program
• Well-being benefits
• Full suite of benefits to support career development, individual & family health, and financial health

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: No Education Listed