Sr System Payer Rel and Contract Mgr

General Summary

This position will serve as the lead contracting contact for University of Maryland Medical System (UMMS) for assigned payers. Acts as the primary contact with these payer organizations, utilizes revenue protection and growth strategies to assess contracting opportunities, conducts contract negotiations/ renegotiations, and manages contracts to maximize actual/expected revenues. In addition, this position will work in conjunction with the UMMS Clinically Integrated Network (CIN) staff to lead CIN payer contracting efforts. Conducts market research as necessary and engages and secures buy-in of constituent leadership, and administrative staff for awareness and compliance with contract terms.

Principal Responsibilities and Tasks

The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all job duties performed by personnel so classified.

1. Establish and maintain relationships with assigned payers which include local, regional and national payers, employers, reinsures, and national networks. Serves as a resource regarding payer market trends.

• Maintain payer profile information.
• Assess payer market share and intelligence.
• Maintain payer relations.

2. Negotiate/renegotiate system-wide traditional and CIN Value-based Care (VBC) contracts including professional, hospital, skilled nursing and ancillary services (home health, DME, infusion, etc.) to achieve optimum contract terms.

• Develop and execute various contracting strategies to protect and improve revenues.
• Collaborate with financial, operational, clinical staff and leadership to identify opportunities and employ risk-contracting and/or value-based strategies.
• Negotiate optimal reimbursement for UMMS entities.
• Collaborate with leadership to finalize contract language, operating provisions and financial terms.
• Support contract implementation and training by serving as an expert resource on contract terms.

3. Improve contract performance

• Works cross-functionally to improve contract performance measurement and revenue enhancement initiatives.
• Improve actual/expected revenue on contracts.
• Renegotiate contracts in a timely manner.

4. Responsible for facilitating contract proposals and/or requests for information (RFI) from payers regarding system contracting opportunities.

• Assess financial and clinical opportunity/risk of proposals.
• Evaluate payer’s existing provider network and determine opportunity for revenue and volume.
• Collaborate with leadership, clinical staff and other key personnel to provide data/information responses.
• Define UMMS competitive edge through proposal or request for information (RFI) responses.
• Leads contract negotiations.
• Responsible for informing/advising and obtaining buy-in of leadership on requirements and approach for agreement on payer participation.

Education and Experience

1. Bachelor’s Degree from an accredited college or university in Marketing, Business Administration or a related discipline OR a combination of equivalent experience (in addition to that required in bullet 2) and applicable education is required.*

2. Master’s degree is preferred

3. Seven to ten years progressive experience in a managed care contracting environment, with five years of direct managed care contracting experience required.

*Experience used to fulfill the degree requirement may not also be used to satisfy the work experience requirement. (i.e. Experience may not be double counted.)

Knowledge, Skills and Abilities

1. Extensive knowledge of managed care practices and all facets of payer contracting to include: value-based contracting models and strategies, professional, ASC, skilled nursing, home health, infusion services, etc.

2. Knowledge of medical terminology is required; knowledge of claim coding is preferred.

3. Excellent written and verbal communication skills are necessary, as well as the ability to work independently.

4. Demonstrated effectiveness in leading and executing contracting and payer relations in a highly complex environment. Demonstrated ability to work collegially within complex systems.

All your information will be kept confidential according to EEO guidelines.

Compensation:

Pay Range: $51.82-$77.78

Other Compensation (if applicable):

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