Summary:

Under the direction of the Director of Managed Care, the Managed Care Contract Manager is responsible for the key components of the payer contracting process. The payer contracts include the various terms and conditions by which Baycare’s providers – which include physicians and hospitals – are reimbursed for the services provided to patients. Contracts often include pay for performance programs that incentivize providers for providing higher quality or less costly care.

Primary responsibilities of the Managed Care Contract Manager include performing contract analysis, developing payer strategy, engaging in contract negotiations, overseeing implementation, providing contract support, and serving as a subject matter expert for ongoing operational and strategic issues.

Job Responsibilities:

1) Perform contract analysis – analyze contract language and financial terms, understanding how these align or differ from other payer contracts or industry standards. Analyze performance of contract using a variety of financial and operational sources. Analyze economic, market, and regulatory conditions, to fully understand the environment in which the contract performs.

2) Develop payer strategies – using the above analysis, develop negotiation strategies for maximizing financial performance, limiting operational issues, and positioning the organization for future growth and opportunity.

3) Engage in contract negotiations – be the lead representative in negotiations with payers for new contracts, renewals, or other issues as needed.

Communicate and collaborate with other stakeholders on the progress of negotiations, bringing in resources where appropriate.

4) Oversee implementation – take lead on ensuring post-negotiation steps are properly taken such that operational difficulties are minimized.

5) Provide Contract Support – work with stakeholders on operational and financial issues as they arise. Assist in the development of an overall strategy for the managed care activities. Serve as subject matter expert on various committees and collaborate with teammates on contracting projects and issues.

Skills and Competencies:

1) Knowledge and experience of healthcare billing and reimbursement, including experience with hospital and physician billing. Ideally, experience with payer contracts.

2) Excellent communication and presentation skills, financial acumen, relationship building, ability to tactfully navigate healthcare environment with various key parties.

3) Proficiency in Microsoft Office applications including Word, Excel, and PowerPoint

Required Educational Experience:

Bachelor’s Degree

Preferred Educational Experience:

Master’s Degree

Required Work Experience:

5 years healthcare, managed care, provider or payer expertise

Preferred Work Experience:

Provider contracting, hospital and physician billing, pay for performance programs

You Belong At Baystate

At Baystate Health we know that treating one another with dignity and equity is what elevates respect for our patients and staff. It makes us not just an organization, but also a community where you belong. It is how we advance the care and enhance the lives of all people.

DIVERSE TEAMS. DIVERSE PATIENTS. DIVERSE LOCATIONS.

Education:

Bachelor of Science (Required), Master of Arts

Certifications:

Equal Employment Opportunity Employer

Baystate Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, marital status, national origin, ancestry, age, genetic information, disability, or protected veteran status.

Ab out Baystate Health

Baystate Health (BH) is one of New England’s leading and largest integrated health care organizations, serving a population of nearly one million people throughout western New England. With roots dating back to the founding of Springfield City Hospital in 1873, Baystate Health has been providing high-quality and compassionate health care in western Massachusetts for more than 145 years. With more than 12,000 employees, a medical staff of nearly 3,100 physicians, and a net patient service revenue of more than $1.4 billion, the ever-growing health system includes five Massachusetts hospitals and the Baystate Mary Lane Outpatient Center in Ware:

• Baystate Medical Center in Springfield

• Baystate Children’s Hospital (located at Baystate Medical Center)

• Baystate Franklin Medical Center in Greenfield

• Baystate Wing Hospital in Palmer

• Baystate Noble Hospital in Westfield