What are the responsibilities and job description for the Network Contracting Manager - JHP position at Jefferson Health?
Job Details
Working under the direction of the Vice President, with minimal supervision, negotiates hospital and health system agreements, including associated physician and ancillary agreements, in building and maintaining high-quality and cost-effective provider networks to meet and exceed regulatory and organizational goals. Develops and maintains written contracts and analyzes hospitals and systems for reimbursement rates and contract language. Promotes value-based reimbursement components within hospital and system agreements as directed. Works with departments across the organization to develop support and approval for network contracting activities.
Job Description
Primary Responsibilities:
This position does not have direct reports and may occasionally oversee other staff/vendors on a project basis to execute assigned responsibilities while assuring alignment of priorities and work product with business needs as defined by senior leadership. The position also takes a leadership role in the selection and hiring process.
Work From Home
JHP allows employees to work remotely based on its determination that a remote work arrangement is appropriate based on JHP’s business needs and the employee’s ability to perform the job remotely in an effective manner. Should those business needs change, JHP reserves the right to change the remote working arrangement at any time, in accordance with JHP’s Flexible Remote-Working Policy. JHP will provide a minim notice of 60 days of any change in the remote working arrangement.
Physical Demands
While performing the duties of this job, the employee is regularly required to talk and hear and sit for long periods of time.
Travel
Occasional local travel required for this position.
Work Location
This position is available to work from home; in accordance with our Flexible Remote-Working Policy, who you will be required to acknowledge and sign upon hire.
Key Job Requirements
Education: Relevant bachelor’s degree and/or 5-7 years equivalent combination of work experience.
Experience
(Level & explanation of the level)
Coordinator has access to PHI in working on non-par negotiations, claims/UM issues and analyses.
Compliance Statement: Compliance with all applicable rules, regulations and laws is a condition of employment. Employees must read and sign, both the Business Code of Conduct and the Personal Standard Code of Conduct and are expected to perform their duties ethically and honestly.
Work Shift
Workday Day (United States of America)
Worker Sub Type
Regular
Employee Entity
Health Partners Plans, Inc.
Primary Location Address
1101 Market, Philadelphia, Pennsylvania, United States of America
Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200 undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.
Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.
Benefits
Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.
For more benefits information, please click here
Working under the direction of the Vice President, with minimal supervision, negotiates hospital and health system agreements, including associated physician and ancillary agreements, in building and maintaining high-quality and cost-effective provider networks to meet and exceed regulatory and organizational goals. Develops and maintains written contracts and analyzes hospitals and systems for reimbursement rates and contract language. Promotes value-based reimbursement components within hospital and system agreements as directed. Works with departments across the organization to develop support and approval for network contracting activities.
Job Description
Primary Responsibilities:
- Leads or assists with assigned negotiations for hospital/health system contracts (i.e., hospital, physician, and ancillary) and ensures that negotiations meet the company's strategic and financial goals and objectives.
- Manage the negotiation of rates and language terms for existing and new physicians, ancillary, hospital/health systems, and other related provider agreements.
- Prepares contracts, contract amendments, rate proposals, and rate analyses.
- Facilitates and provides oversight for provider setup and contract configuration to ensure accurate system setup, fee schedule development, and accurate claims adjudication.
- Work with HPP management, other appropriate staff, and health systems to explore, develop, and implement innovative, value-based approaches to contracting.
- Coordinates with internal departments and contracted providers to implement and maintain contract compliance. Recommends operational changes or process improvements to appropriate stakeholders as required.
- Act as subject matter expert regarding physician, ancillary hospital, and health system contracts, and interpret and resolve business questions from network providers and internal customers.
- Recruit providers to meet network adequacy and marketability needs in alignment with health plan goals.
- Ensures that, during negotiations, contracts meet all regulatory requirements.
- Describes contract changes to other departments and reviews existing provider agreements to determine the need for creating new exhibits and amendments based on regulatory changes.
- Maintain and foster collaborative relationships with provider executives and internal and external customers.
- Develop and maintain monitoring tools for negotiated agreements.
- Performs job duties in compliance with applicable policies and procedures.
- He remains informed of industry trends related to physician, ancillary, hospital, and provider contracting and advises senior management of trends and issues that impact JHP.
- Serve as departmental representative/participant on interdepartmental and external work groups/task forces as assigned.
- May perform other duties as assigned.
This position does not have direct reports and may occasionally oversee other staff/vendors on a project basis to execute assigned responsibilities while assuring alignment of priorities and work product with business needs as defined by senior leadership. The position also takes a leadership role in the selection and hiring process.
Work From Home
JHP allows employees to work remotely based on its determination that a remote work arrangement is appropriate based on JHP’s business needs and the employee’s ability to perform the job remotely in an effective manner. Should those business needs change, JHP reserves the right to change the remote working arrangement at any time, in accordance with JHP’s Flexible Remote-Working Policy. JHP will provide a minim notice of 60 days of any change in the remote working arrangement.
Physical Demands
While performing the duties of this job, the employee is regularly required to talk and hear and sit for long periods of time.
Travel
Occasional local travel required for this position.
Work Location
This position is available to work from home; in accordance with our Flexible Remote-Working Policy, who you will be required to acknowledge and sign upon hire.
Key Job Requirements
Education: Relevant bachelor’s degree and/or 5-7 years equivalent combination of work experience.
Experience
- 3-5 years of hospital or ancillary contracting experience in a managed care setting (payer or provider based).
- Strong knowledge of hospital and provider reimbursement methodologies
- 3-5 years’ experience with Medicare, Medicaid, and value-based reimbursement methodologies preferred.
- 5-7 years’ Experience with provider recruitment, customer service and claims payment.
- In-depth knowledge of the managed care industry and practices, as well as a strong understanding of competitor strategies, practices, and financial/contracting arrangements.
- Excel at maintaining positive working relationships internally and externally.
- Superior organization and follow-up skills.
- Excellent written and oral communication skills.
- Strong quantitative analytic abilities.
- Careful attention to detail.
- Ability to represent Health Partners independently with external providers.
- Advanced knowledge of Microsoft Excel, Word, and PowerPoint preferred. Intermediate knowledge required.
- Knowledge of provider payment methodologies for Medicaid, Medicare and Commercial lines of business.
(Level & explanation of the level)
Coordinator has access to PHI in working on non-par negotiations, claims/UM issues and analyses.
Compliance Statement: Compliance with all applicable rules, regulations and laws is a condition of employment. Employees must read and sign, both the Business Code of Conduct and the Personal Standard Code of Conduct and are expected to perform their duties ethically and honestly.
Work Shift
Workday Day (United States of America)
Worker Sub Type
Regular
Employee Entity
Health Partners Plans, Inc.
Primary Location Address
1101 Market, Philadelphia, Pennsylvania, United States of America
Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200 undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.
Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.
Benefits
Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.
For more benefits information, please click here