Managed Care Contract Analyst

Job Description Summary

Manages specific components of health system's hospital and physician managed care contracting, consistent with system's strategic objectives in managed care, as directed by South Shore Vice President, Managed Care/Integrated Delivery Network (IDN) Executive Director. Maintains broad responsibility within those components, from evaluation of opportunities through negotiation and contracting to implementation and monitoring. Provides general support to VP, Managed Care/Executive Director to ensure the system's overall managed care objectives are met, contractual and policy changes are shared and implemented, and to respond to institutional priorities.

Job Description

ESSENTIAL FUNCTIONS

  • Negotiates and manages Hospital, Physician and IDN participation with managed care plans, with responsibility for evaluation of new opportunities and proposals with respect to South Shore's managed care strategy and contracting and financial standards.  Negotiates and implements contracts.
    • Negotiates within the guidelines provided by contracting leadership, and develops tactical plans and timelines for negotiation process.  
    • Analyzes new managed care proposals against System managed care strategy, and creates and provides timely counterproposals to managed care plans.
    • Works with South Shore revenue cycle and operational teams to identify impacts and implement new contracts/products within one month of receipt and prior to effective date.
    • Educates other managed care, revenue cycle, population health, billing, and coding staff on changes in contract.
    • Works with IT and Revenue Cycle teams to ensure contracts are properly loaded and tested in billing systems.
    • Evaluate contract language against best practice and evaluates impact of any new proposed contract language.
    • Partner with South Shore clinical and operational leadership to evaluate the achievability and reasonableness of any value-based care contractual components.
  • Provides general support to VP Managed Care/Executive Director IDN in meeting South Shore's managed care objectives.  Coordinates activities of others throughout System as needed to achieve objectives.
    • Follows up and resolves problems related to managed care in a timely manner.
    • Represents managed care needs of South Shore in internal and external meetings in lieu of other South Shore leadership.
    • Provides regular status updates to leadership on progress and unresolved issues.
    • Creates annual managed care renewal cycle timeline to effectively plan for upcoming contract renewals.
    • Works with leadership to identify goals and strategies for each managed care contract renewal.
  • Performs market research and analysis for new markets or products (for example: direct contracting, value-based care models, benefit designs workers compensation, etc.).  Evaluates new opportunities with respect to market acceptance, and consistence with SSH strategy, contracting and financial standards.
    • Performs analysis within required timeframes.
    • Maintains up-to-date knowledge of managed care industry and its products.
    • Provides concise written summaries of findings.
    • Maintains data base and files in organized manner.
  • Provides analytic and technical support to VP Managed Care.  Performs other managed care-related activities as needed.
    • Performs all projects within the required timeframe.
  • Embraces technological solutions to work processes and practices. 
    • Utilizes Epic, Arcadia, and Experian modules to gather information.
    • Utilizes Microsoft Excel and Word proficiently.
  • Fosters a “Culture of Safety” through personal ownership and commitment to a safe environment.
    • Utilizes proper body mechanics when performing all aspects of job.
    • Operates equipment safely.
    • Adheres to respiratory etiquette guidelines.
  • Technology and Learning
    • Participates in continued learning and possess a willingness and ability to learn and utilize new technology and procedures that continue to develop in their role and throughout the organization.
    • Embraces technological advances that allow us to communicate information effectively and efficiently based on role.

Job Requirements:

Minimum Education

Bachelors degree in Business, Finance, Economics, Healthcare Administration or related field required. Graduate degree preferred (MBA, MHA).

Minimum Work Experience

  • Minimum two to three (2-3) years of directly related healthcare experience.
  • Experience includes work in managed care for a health plan, physician group, or hospital, specifically work with financial analytics, and contract language review, and past work with hospital and physician reimbursement modeling.
  • Negotiation experience (with both fee-for-service and value-based contracts) preferred.
  • Knowledge of the healthcare delivery system (including value-based care models and trends) and familiarity with Medicare, Medicaid, and Commercial insurance/HMO products required.

Required additional Knowledge, and Abilities

  • Thorough working knowledge of PC software.
  • Ability to interact with various departments throughout the system acting as liaison to the finance department and IDN.
  • Ability to work independently and identify priorities based upon the needs of multiple constituencies.
  • Must have strong communication skills (oral and written) and strong relationship building skills.