Responsibilities:

·        Plan, strategize and oversee daily operations of the Balance Billing & Fee Negotiation, and Contracting units under Provider Relations department

·        Oversee and manage the Balance Billing & Fee Negotiation unit, an area responsible for handling NSA (No Surprises Act) and IDR (Independent Dispute Resolution negotiations, and other negotiations associated with members balance billed by providers including facilities for voluntary and involuntary access to participating and non-participating providers by eliminating and reducing out-of-pocket cost incurred by the members; oversee and negotiate rates for out of network hospital and medical services

·        Oversee and manage contracting activities with all facility type, including freestanding ASCs, vendors, and ancillary providers and enforce contract compliance

·        Responsible for the maintenance of the contract documents, including professional agreements, letters of agreement, amendments, ancillary, facility and hospital services agreements; ensure that any changes to the contract templates are approved by the Legal Department

·        Facilitate the negotiation of contract rate and terms upon requests within applicable financial and operational goals; capture, monitor and report on key metrics

·        Collaborate with the Funds’ outside fiduciary to implement rates for inpatient and outpatient hospitals services; respond to provider issues and concerns to ensure high volume hospitals, vendors, and networks are managed effectively

·        Manage staff in accordance with established department procedures, Human Resources guidelines and provisions of the Collective Bargaining Agreement

·        Honor commitments consistent with organization and department’s vision, behave ethically and act with integrity, and communicate with candor

·        Be passionate about the members we service, set high expectations and be accountable, collaborate with other departments and other Provider Relations areas to develop or refine shared workflows

·        Perform additional duties and projects as assigned by management

Qualifications

·        Bachelor’s degree in business or health related field required; Master’s Degree preferred.

·        Minimum six (6) years relevant experience in managed care, contracting, and network management including four (4) year supervisory experience required

·        Knowledge of fee negotiations, reimbursement methodology, and contract language review process

·        Broad knowledge and understanding of applicable laws, regulations, requirements, and protocols in compliance and adherence (ERISA, DOL, HIPAA, PHI, ACA)

·        Excellent written, organizational and communication skills; detail-oriented with interpersonal and team building skills

·        Knowledge of hospital and medical claims adjudication process, medical billing and coding terminology, and Medicare and industry billing policies and procedures

·        Proven multi-tasking skills and ability to meet critical deadlines

·        Intermediate level of Microsoft Suite/365, Word and Excel