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Professional & Alternative Payment Network Contract Lead

Location: Buffalo, NY, United States
Date Posted: Oct 16, 2020

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Job Description

Facility: Administrative Regional Training Cntr

Status: Full Time

Work Schedule: Days

Bargaining Unit: ACE Associates

Exempt from Overtime: Exempt: Yes

Hours: 8a-4p

Shift: Shift 1:

FTE: 1.000000:



Summary:


With an eye toward value based payment and population health management, the Professional & Alternative Payment Network Contracting Lead specializes in and implements the managed care strategies of the organization through contributing to and at times leading the negotiating of contracts and provisions for Catholic Health professional service entities. This individual works in collaboration with Catholic Medical Partners (CMP) as well as independently on any agreements related to alternative payment models or value based reimbursement. The position ensures that contracts are operational and functional throughout the organization, interacts with other departments to ensure payment accuracy, contract adherence and resolves contract related issues with payers and internal stakeholders. This individual works closely with Catholic Health clinical leadership as well as payer representation on contractual and related items, including development of alternative payment models applicable to professional, facility based and home and community based care service areas. These functions include analysis and reporting functions related to the financial performance of payer contracts, quality and clinical integration incentive programs and related items. The Professional & Alternative Payment Network Contracting Lead will be responsible for ongoing communication throughout the organization related to managed care contracts and specific payer programs related to applicable ministries and maintaining strong relationships with the hospital and System Finance team, Revenue Management Team and Business owners of Catholic Health.

Responsibilities:


EDUCATION
  • Bachelor's degree required
  • Master's degree preferred

EXPERIENCE
  • Three (3) years managed care related experience required
  • Five (5) years healthcare experience preferred
  • Prior experience in professional, long term care, home care and/or DME preferred
  • Prior management experience preferred, but not required
  • Strong knowledge of healthcare reimbursement and billing practices preferred
  • Strong knowledge of risk/value based contracting and insurance negotiations preferred

KNOWLEDGE, SKILL AND ABILITY
  • Must be knowledgeable regarding managed care concepts, health care reimbursement, and financial analysis
  • Strong written and verbal communication skills required
  • Negotiation experience
  • Ability to take initiative in implementing new ideas, identify opportunities for improvement and to make innovative changes
  • Strong organizational skills
  • Proficiency in the use of technology (such as reporting tools, excel, word, power point and others)
  • Demonstrated strength in working with multidisciplinary teams



WORKING CONDITIONS
  • General office work, local travel, occasional early mornings and evenings required.



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