New England Quality Care Alliance (NEQCA) a physician network based out of Braintree is seeking a full time Manager of Contracting. Under the direction of the Senior Director, Contracting and Network Operations, manages contracts on behalf of New England Quality Care Alliance ("NEQCA"). Participates in the negotiation and manages the execution and implementation of managed care contracts; participates in senior level committees; monitors contract performance; and assists in development of expanding contract opportunities. Applies knowledge of the healthcare industry to communicate contract terms and conditions to key personnel and Department:s. Assists in strategic assessments and business development for NEQCA.
RESPONSIBILITIES:
Responsible for assisting with and executing contracting initiatives in accordance with NEQCA business requirements, quality incentive programs and unit cost trend budget requirements.
Lead negotiator for an assigned portfolio of ancillary vendor and special pricing agreements.
Provide key negotiation support for highly complex risk sharing financial arrangements with health insurance plans.
Responsible for assisting in the development of rate proposals using modeling tools.
Responsible for working with Informatics and Finance and Local Care Organization stakeholders to ensure communication of key objectives and responsibilities to support contract negotiations.
Responsible for managing all aspects of negotiations pertaining to contract language and rates, including primary responsibility for the accuracy of all contract language proposals, rate proposals and final contracts for signature. Particular focus on the detailed aspects of both provider and system level contracting impacts and areas of concern.
Support contracting initiatives in accordance with NEQCA business requirements, quality incentive programs and unit cost trend budget requirements.
Ensure new rates for health plan agreements are successfully communicated within the organization.
Ensure that health plans are compliant with rate loading and other operational terms in accordance with contract effective date.
Work effectively with multiple Department:s to ensure that contracts are compatible with NEQCA operations and structure.
Contribute to the development of creative contracting strategies, reimbursement structures and approaches
Provide training and development to non-contracting support staff.
REQUIREMENTS:
BS/ BA required. Master’s degree in Business Administration, Health Care Administration or equivalent preferred.
Minimum of five (5) years experience in managed care contracting, financial analysis, reviewing of contracts and drafting of language provisions; or an equivalent combination of education and experience.
Solid understanding of global, hospital and physician contract development; demonstrated negotiation of physician agreements; demonstrated strength in finance to support financial arrangements and analysis; demonstrated understanding of health care reimbursement methods and strategies.
Demonstrated ability to influence, negotiate, and operate collaboratively as part of a team.
Excellent written/verbal communication skills; effective presentation skills; project management and planning skills critical.
Requires superior interpersonal, communication and presentation skills to effectively supervise staff, and work and communicate with all levels of management throughout NEQCA and Tufts Medical Center. Must be able to effectively translate between health plans and provider communities.