Contract Manager

Contract Manager

BHPS is seeking a Contract Manager responsible for the contracting and maintenance of the relationship with network health systems in their assigned territory or specialty. This also includes the recruitment, and management of the provider network inclusive of hospitals and physician groups in the New York metro market. The successful candidate will perform all of the requisite due diligence activities to identify and secure new relationships and contracts as needed with providers and re-contract with existing providers to ensure cost effective and competitive arrangements. The Contract Manager will also coordinate with other areas as appropriate to incorporate a sound strategic approach to provider network development. The Contract Manager is a strategic and operationally oriented professional that will help build partnerships with our network, bring an analytic mindset to discussions and manage and execute projects including network development and provider outreach. Success in this position is based on strong communication skills and solid relationships with internal and external stakeholders. This position is a hybrid position and can be based in our Long Island office.

Primary Responsibilities

• Review, analyze, negotiate, implement, and maintain existing contracts with an understanding of professional rate schedules and contractual language.
• Identify network development opportunities through financial analysis, client requests, and product development.
• Define performance improvement opportunities.
• Implement new and evolving strategic contract initiatives including alternative payment methodologies, e.g. bundling, value-based payment, pay for performance.
• Analyze reports on cost, utilization, claim submission patterns and outcomes. Prepare presentations on subsequent findings.
• Develop, implement, and support the ongoing efforts to build new network solutions and deploy solutions as appropriate.
• Assist in resolution of provider issues, including root cause analyses, mediation between parties, and strategic relevance to the organization and its clients.
• Partner with different areas for outstanding payments, medical management, and provider policy.
• Other duties and projects as assigned and specified by supervisor in line with department and company needs.

Essential Qualifications

• Minimum 5 years in a provider or hospital administration role.
• Strong understanding of contract language.
• Strong understanding of professional provider cost structures and reimbursement methodologies.
• Sound knowledge of healthcare contracting.
• Demonstrated analytical & negotiation abilities, with excellent communication and presentation skills.
• Ability to multi-task.
• Organized and methodical.
• Customer service skills.
• Proficiency in Excel.

Preferred Qualifications

• 5 years in a provider contracting role with existing market relationships.
• Experience in financial or actuarial modeling.
• Expert proficiency in Excel.
• SQL and access experience.
• Understanding of provider experience and clinical operations.
• Revenue cycle management.
• Master's Degree.

At Brighton Health Plan Solutions, LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, you'll become part of a diverse and welcoming culture focused on encouragement, respect and increasing diversity, inclusion and a sense of belonging at every level. Here, you'll be encouraged to bring your authentic self to work with all of your unique abilities.

Brighton Health Plan Solutions partners with self-insured employers, Taft-Hartley Trusts, health systems, providers as well as other TPAs, and enables them to solve the problems facing today's healthcare with our flexible and cutting-edge third-party administration services. Our unique perspective stems from decades of health plan management expertise, our proprietary provider networks, and innovative technology platform. As a healthcare enablement company, we unlock opportunities that provide clients with the customizable tools they need to enhance the member experience, improve health outcomes and achieve their healthcare goals and objectives. Together with our trusted partners, we are transforming the health plan experience with the promise of turning today's challenges into tomorrow's solutions.

Come be a part of the Brightest Ideas in Healthcare™.

Transform the health plan experience – how health care is accessed and delivered – by bringing outstanding products and services to our partners.

Redefine health care quality and value by aligning the incentives of our partners in powerful and unique ways.

JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Brighton Health Plan Solutions in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All of our career opportunities are regularly published and updated brighonthps.com Careers section. If you have already provided your personal information, please report it to your local authorities. Any fraudulent activity should be reported to: View email address on click.appcast.io