Manager, Provider Contracting

 Bravo Health is a premier provider of managed care services for people with Medicare.  If you are looking for a career with a dynamic company with significant opportunity for growth, we'd love to hear from you.  We are experiencing rapid growth, and are currently seeking a Manager of Provider Contracting.

 

POSITION SUMMARY:

 

The Manager, Provider Contracting is responsible for contracting with the appropriate vendors, ancillary, physician and hospitals, providers to ensure that all operational, regulatory requirements, and health care needs of Bravo Health Members are met.  This home based position addresses the servicing needs of contracted institutions and capitated networks in the following activities: (a) provider relations and (b) management of provider network (c) regulatory compliance of the agreements and network practitioners and providers.  Monitors the level of provider satisfaction with all departments within Bravo Health and addresses any issues with the appropriate department(s).  This position reports directly to the Vice-President of Network Management, Mid-Atlantic.

 

 

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following:

 

 

Ø  Identifies institutional and ancillary service providers with whom to contract.  Coordinates with captive sales and broker sales management at Bravo, Institutional-Based program staff, and Health Services staff to identify appropriate providers.  Develops contractual relationships with these providers.  Ensures coverage and credentialing standards are met with primary care, specialty and ancillary providers for each Bravo Health site of operation.

 

Ø  Manages orientation programs for institutional, ancillary and capitated providers within the Bravo Health system.  Assists providers in understanding payment options and negotiating the most appropriate reimbursement methods.  Communicates pay arrangements to the appropriate Bravo departments.

 

Ø  Works with the senior management to evaluate and develop expansion markets within beyond the current service area.  Primary contact, resource and knowledge base for all network development related issues within existing, new and proposed service area(s).

 

 

Ø  Uses Medical Economics’ financial modeling tools to assist in the provider negotiation process ensuring that the financial risk of the Company is protected.  Coordinates analysis with Medical Economics, as appropriate.

 

Ø  Develops and implements external strategic initiatives with providers to ensure Bravo Health is able to meet and exceed its financial, operational and regulatory objectives and responsibilities.

 

Ø  Oversees generation of single-case agreements and negotiates appropriate out-of-network arrangements for unplanned services such as out-of-area institutional admissions and emergency specialty care, and documents such arrangements. 

 

Ø  Enforces contract terms.  Negotiates changes to contract terms.  Assists with disciplinary action, when necessary.  Maintains accurate listing of participating providers and services including, but not limited to, the Provider Manual and Provider Directory.  Maintains contract summaries and provides staff with relevant information for contract management and for accessing contracted services.

 

 

ESSENTIAL JOB TASKS

 

Possesses the analytical and technical skills required to evaluate alternative pricing options. 

 

Ability to manipulate Bravo Health data, using ad hoc report retrieval and Microsoft Office  software.  (Microsoft Access skills desirable).

 

Familiarity with procedural coding and professional and institutional billing conventions, and Medicare pricing concepts.

 

Ability to communicate effectively with providers in a negotiation setting, and achieve a reasonable settlement of issues when factors require a common sense approach.

 

Identify provider concerns and submit evaluations for analysis and problem resolution.

 

 

ADDITIONAL JOB TASKS

 

·  Other duties as assigned

 

EDUCATION

 

·  Bachelor’s degree or equivalent work experience

 

 

EXPERIENCE

 

·  1-3 Years of prior Provider Relations, Provider Services or managed healthcare experience

·  0-2 years of physician recruitment experience

·  Thorough knowledge of the Managed Care Industry and clinical terminology

·  Ability to travel within the designated area

 

 

COMPUTER SKILLS

·  MS Office Suite; particularly MS Access

 

 

 COMMUNICATION SKILLS

·  Strong negotiation skills

·  Excellent relationship building/interpersonal skills

·  Solid oral, written and presentation communication skills

·  Ability to work collaboratively with providers

 

PROBLEM SOLVING

 

·  Ability to analyze and solve complex problems created and presented by the business environment

 

DECISION MAKING

·  Ability to prioritize assignments

·  Ability to exercise independent judgment within established company guidelines

·  Must possess strong attention to detail

·  Solid time management skills

 

SUPERVISION

N/A

 

PHYSICAL DEMANDS/WORK ENVIRONMENT

·  Substantial amounts of walking may be required

·  Current Driver’s License and Automobile required

·  Ability to work independently

·  Ability to use a computer keyboard and view a monitor

·  May work extended hours based upon business necessity

 

Located in Canton just a couple of blocks from the Canton Square, we offer excellent benefits including health, dental, employer-paid short & long term disability and life insurance, a generous 401K match, tuition reimbursement, flexible spending account and free on-site parking.