Contract Administrator, System Payer Contracting

Contract Administrator, System Payer Contracting

The Contract Administrator, System Payer Contracting makes data-supported recommendations, supports the development of AMHS contracting strategies, and, as assigned, negotiates with established and new payers, both commercial and governmental. Support functions include but are not limited to economic and risk assessments in collaboration with System Finance and ensuring implementation and operational performance of such contracts, consistent with the negotiated terms. The Contract Administrator prepares contract proposals for internal review and consideration, prepares for and conducts meetings/negotiations, presentations, and other organizational functions as assigned. The Contract Administrator maintains strong relationships working collaboratively across AMHS and payer organizations. This includes but is not limited to coordinating operational input across all applicable System departments including Practice and Hospital Administration, Billing, Finance, Information Systems, Utilization Management, Quality, Credentialing, Managed Care Organizations, payer, and other related internal and external entities. For each AMHS contract portfolio the Contract Administrator assists with the development of reporting instruments including but not limited to contract performance parameters and/or profit/loss comparisons by service. The Contract Administrator works collaboratively within the Department to develop payer profiles to include but not limited to membership, market share, financials, products and volumes at AMHS.

Qualifications

Education: Bachelor's Degree in Business and/or Health Care Administration required. Equivalent combination of relevant education and experience may be substituted as appropriate.

Experience: 4-6 years in managed care negotiations and managed care network operations required and 1-3 year in and able to lead complex payer negotiations and mediation.

This office is located at 1275 Broadway, Albany NY. However, this position will be required to travel to our affiliate locations for scheduled meetings which include: The Saratoga Hospital, Glens Falls Hospital, Columbia Memorial Hospital.

The Contract Administrator, System Payer Contracting meets with representatives of payers, managed care organizations and other agencies to assist in the evaluation of current contracts or development of new contracting opportunities to include those under Federal and NYS reform for AMHS. Reviews proposals and makes data informed recommendations for internal consideration in preparation for negotiations.

In conjunction with the Director or at the direction of VP for Payer Contracting negotiates contract parameters and methodologies and prepares/presents proposals representing AMHS's position. Works cross functionally across AMHS to evaluate and develop such proposals identifying opportunities and risks. Presents such opportunities and risks as directed. Collaborates with the Legal and Compliance Department and other departments across AMHS to ensure compliance and implementation capabilities.

Works cross functionally across AMHS to review terms and performance of each established contract portfolio; makes data informed recommendations for methodology changes including but not limited to those related to value based payment identifying opportunities and risks.

Mediates contract disputes to resolution and ensures compliance (both internally and externally) with contract provisions.

Monitors contract renewal dates to ensure appropriate review is conducted. Coordinates with Finance and others to ensure timely/applicable contract analyses. Reviews for risks and works collaboratively with Financial Reporting to ensure appropriate modeling. Understands all modeling parameters and reports on such.

Responsible for contract education to various System-wide departments, including executive leadership, Finance, Billing, Practice Administration as required. Responds to requests for further information and follow-up as required.

Plans presentations and meetings including preparing narrative, overheads and handouts as assigned. Ensures accurate reporting in all prepared presentations for documentation/archiving.

Monitors contract performance by independently collecting data, analyzing and completing spreadsheets to include comparative and economic assessments and reports on such. Works collaboratively with Data Analytics to develop routine reporting instruments for AMHS.

Maintains broad knowledge of payers in the AMHS market and beyond, whether contracted or not. Assists with gathering of current data on all major managed care organizations, including information regarding: financials, current membership, physician networks and current/future marketing plans. Assists with the development of and prepares/presents reporting instruments for the AMHS.

Maintains the absolute confidentiality of patients and AMHS contracts.

Promotes and contributes positively to System-wide, intra-departmental and inter-departmental relationships by cooperating with the resolution of conflicts which may develop.

Performs special projects and assignments as requested by the Director or VP for Payer Contracting. Assists with IDS Affiliate contracting processes related to payer contracting.

Knowledge base must remain current in changes regarding Federal and New York State regulations of provision/reimbursement of medical services including but not limited to federal and NYS VBP Roadmaps.

Thank you for your interest in Albany Med Health System! Albany Med Health System is an equal opportunity employer.

This role may require access to information considered sensitive to Albany Med Health System, its patients, affiliates, and partners, including but not limited to HIPAA Protected Health Information and other information regulated by Federal and New York State statutes. Workforce members are expected to ensure that:

Access to information is based on a "need to know" and is the minimum necessary to properly perform assigned duties. Use or disclosure shall not exceed the minimum amount of information needed to accomplish an intended purpose. Reasonable efforts, consistent with Albany Med Health System policies and standards, shall be made to ensure that information is adequately protected from unauthorized access and modification.