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Senior Manager, Payer Contracting JobN/A, N/A

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Why You'll Love This Job

Position Summary

The Manager, Payor Contracting, is accountable for developing and achieving contracting objectives for its target market and/or designated payor relationships. This includes developing and achieving rate lift goals, obtaining new payor contracts as prioritized by the business, amending existing contracts to participate in new lines of business, products, programs and recommending terminations when in the best interest of BrightView.

This position is responsible for proactively establishing and maintaining engagement with key representatives of the managed care plans to achieve BrightView’s contracting goals.

As needed, this position will consult to interpret contractual rights and responsibilities and/or payor requirements to help resolve escalated payor issues.

Job Responsibilities

  • Complete contract reviews and financial modeling that support on-going contract maintenance and negotiations.
  • Establish and align criteria for “good” contract terms across rates, language and administrative terms.
  • Negotiate contracts with targeted payors to improve rates, language, and administrative terms.
  • Establish new contracts at favorable terms with targeted payors, to expand BrightView services into new markets.
  • Perform contract language reviews and financial modeling to quantify and recommend next steps with any given payor.
  • Inform annual contracting plan, rate forecast, and prioritization of new contracting initiatives.
  • Coordinate alternative payment model (APM) and value-based contracting (VBC) opportunities with Director and VP, Managed Care and finalize contracts as approved.
  • Proactively engage Contract Administration and Credentialing team to ensure BrightView providers are credentialed prior to effective date of contract.
  • Accurately document key contract terms in contract management system, for Contract Administration’s successful implementation, education and load of contracts.
  • Track engagement with payors on BrightView’s customer relationship management (CRM) platform
  • Ensure duly executed contracts with clear fee schedules are provided to Contract Administration, for standardization and centralization of contract documents, fee schedules, and applicable correspondence.
  • Collaborate with Contract Administration and RCM, to monitor payor compliance with contractual obligations and escalate with payor contracts as warranted.
  • Serve as first line response for Managed Care inquiries, e.g., contract interpretation, administrative requirements, billing methodologies, etc.
  • Provide required subject matter expertise, engage key contacts/leadership at the payor, and attend Joint Operating Committee meetings as necessary to help resolve large, complex issues.
  • Measure and record results of contracting efforts to inform KPI reporting to C-Suite.

Job Qualifications

  • 3-5 years of managed care experience in a payer or provider setting
  • Must have working knowledge of contemporary managed care policies, practices, and reimbursement mechanisms; familiarity with revenue cycle and patient access functions is preferred.
  • Ability to self-direct and work independently, while seeking guidance when appropriate
  • Exceptional verbal and written communication and presentation skills.
  • Moderate experience with financial modeling as it relates to contract performance
  • Must be highly detail-oriented

Skills & Qualifications

Job Qualifications

  • 3-5 years of managed care experience in a payer or provider setting
  • Must have working knowledge of contemporary managed care policies, practices, and reimbursement mechanisms; familiarity with revenue cycle and patient access functions is preferred.
  • Ability to self-direct and work independently, while seeking guidance when appropriate
  • Exceptional verbal and written communication and presentation skills.
  • Moderate experience with financial modeling as it relates to contract performance
  • Must be highly detail-oriented
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Job Number: 7237

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