Senior Contract Manager at Blue Cross & Blue Shield of Rhode Island — Providence, RI

Pay Range:

$83,200.00 - $124,800.00 Please email HR_Talent_AcquisitionTeam@bcbsri.org if you are a candidate seeking a reasonable accommodation for the application and/or interview process.

Why this job matters:

Negotiate and implement complex contracts with hospitals, physician partner groups, and other health care providers and vendors. Focus on achieving the organization’s financial and business objectives via its contractual relationships with hospitals, physician partner groups and other health care providers and vendors. Serve as a departmental technical expert and coaches, mentors, and assists other Contract Administrators. Serve as trusted resource to Hospital, Physician and/or Ancillary management staff.

What you will do:

• Analyze financial terms and evaluate contractual language during negotiation of complex provider agreements.
• Coordinate the implementation and the administration of new hospital, physician partner group, ancillary and vendor contracts.
• Evaluate, negotiate, and recommend necessary changes to existing contracts to ensure mutual success of the company and partners.
• Develop and maintain business relationships between the BCBSRI hospitals, physician partners, ancillary providers and vendors to ensure the effective and ongoing exchange of information. Counsel and educate the partners in the use of company data and resources to achieve quality, performance, and financial objectives.
• Monitor, analyze, and report on contract compliance. Explain and interpret the contracts to educate hospitals, physician partners, ancillary providers and vendors relative to issues of non-compliance. Initiate changes and recommend solutions to improve ongoing compliance and ensure objectives are met in future contract periods.
• Act as a liaison to providers’ staff; ensure understanding of company policies, administrative procedures, and practices. Provide training as required to ensure staff have the resources to meet performance goals and objectives. Develop and implement feedback mechanisms to determine satisfaction levels relative to administrative support, service, communications, and reimbursement. Ensure that Providers’ issues and concerns are addressed by the organization.
• Perform special projects as assigned, which may include work on committee or task forces, research, analysis, communications. Interpret, educate, recommend, and communicate results of research.
• Mentor and provide expert technical, business and analytical support to inter-department teams.
• Lead department projects and initiatives.
• Perform other duties as assigned.

What you need to succeed:

• Bachelor’s degree in Business, Health Care Administration, or related field, or an equivalent combination of education and experience
• Five to seven years in managing and negotiating comprehensive, complex contracts
• In-depth understanding of provider delivery models, provider financing as well as health plan operations and financing
• Highly proficient in developing, interpreting and utilizing provider financial and quality data
• Strong knowledge of provider reimbursement as well as pay for performance models
• Solid understanding of provider billing/claims processing practices, coding standards as well as industry standard payment and medical policies
• Strategic and critical thinking skills
• Strong analytical skills
• Strong business acumen and political savvy
• Strong negotiation skills
• Strong written and verbal communication skills
• Strong problem-solving skills
• Ability to work effectively with a wide variety of people in individual and group settings
• Strong organizing skills, with the ability to prioritize and respond to shifting deadlines
• Strong time management skills
• Ability to manage diverse and deadline-oriented workflow

The extras:

• Master’s degree in Business or Health Care Administrator

• In-office: onsite 5 days per week
• Hybrid: onsite 2-4 days per week
• Remote: onsite 0-1 days per week. Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia