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This is a hybrid role with the expectation that the selected candidate must be willing to travel to the Grand Rapids, Kalamazoo, or Traverse City service areas on a periodic basis.
GENERAL SUMMARY:
Through its provider contracting function, HAP is looking to secure Alternative Payment Model (APM) agreements with POs, PHOs, IPAs and clinically integrated network (collectively APM Entities or APMEs) which reward providers for managing the total cost of care (TCOC), quality (e.g. MA Stars), accurate data collection that results in appropriate risk score recognition, general performance improvement initiatives (e.g. leakage avoidance) and member growth.
The Senior Provider Contract Administrator (SPCA) will be responsible for supporting provider contracting for designated accounts as assigned by the Vice President, PNM and under the direction of a Director, PNM using a coordinated team approach, which typical includes the Director, the SPCA and one or more Provider Services Administrators. Contract support will include preparation for negotiation involving a number of financial and other analyses such as unit price benchmarking, price transparency analysis, alternative provider unit price and lower cost setting analysis and certain market competition analyses.
The SPCA will also audit current claims processing unit price configuration against the contract then in effect. During contract negotiation, the SPCA will evaluate counteroffers and their economic impact, and coordinate additional analyses with HAP’s Provider Reimbursement unit if required to determine economic impact or the impact of a change in payment methodology. The SPCA will also document the results of contract negotiation sessions in a transparent process with providers that notes agreed items, open items and the current status of negotiation.
The SPCA will draft contract language from HAP approved templates and furnish to legal counsel for review and approval. The SPCA will document the economic impact of the new agreed unit prices in relationship to the then existing unit prices given an assumed volume benchmark and participate in preparation of documentation to facilitate claims processing configuration of contract unit prices and terms. An SPCA may also be tasked with leading a contract negotiation without Director involvement in negotiations for accounts of lesser dollar volume and monitor implementation of annual rate changes for multi-year contracts for assigned accounts.
PRINCIPLE DUTIES AND RESPONSIBILITIES:
EDUCATION/EXPERIENCE REQUIRED:
Full Time
$152k-194k (estimate)
03/30/2024
05/29/2024