Provider Network Manager

The Manager, Network Contracting, provides leadership in achieving the goals assigned to the network contracting team. The manager will be principally responsible for the management/renewal of all hospital contracts. This position is also responsible for overseeing the performance of the three provider network specialists already in place. Agreements may be Medicare based reimbursement, DRG based, % of charges, per diem and possibly service specific or value-based in nature. This position will work closely with the senior financial analyst to prepare for every facility contract negotiation. Typical activities will include financial analysis, rate modeling, reimbursement and contract negotiation, trouble-shooting contract issues and access analysis. This person will report directly to the Director, Provider Network Management. Other key relationships will include the Credentialing Analyst and Medical Management staff.

Duties and Responsibilities

40% Facility Contract Solicitation, Negotiation, Renewal and Management

• Responsible for establishing and nurturing relationships with the key contacts at the targeted or contracted facilities.
• Negotiates contracts that are of moderate to high complexity with minimal supervision from the Director.
• Works to communicate and interpret contractual terms to the TPA and financial analyst
• Monitors financial performance of all facility contracts.
• Proposes reimbursement terms based on analysis and knowledge of billing issues, coding issues, utilization history/projections and hospital costs.
• Stays current on trends related to health care reform as well as with reimbursement and coding.
• Ensure OSUHP compliance with facility contract exceptions.

20% Managing Network Strategy

• Identifies strategies, objectives and issues relative to assigned areas of contracting responsibility.
• Evaluates and leads in negotiating contracts in accordance with departmental policies and procedures.
• Assists Director, Provider Network Management with network strategy development, especially as it relates to contracting.
• Problem solves on issues related to Ohio PPO Connect contracting challenges. Communicates effectively to Ohio PPO Connect partner organizations as necessary.
• Stays current on trends related to health care reform as well as with reimbursement and coding.

40% Managing the Provider Contracting Team

• Directing the contracting efforts of the three Provider Network Specialists on staff
• Standardize process and analyze individual through-put to achieve the best results
• Develop provider office visitation schedule that supports NCQA guidelines
• Facilitate the cross-training of contract specialists for better coverage during illness or vacation.
• Review GeoAccess Reporting to recommend adding or removing certain providers from the network; incorporating the contracted rate differential among those under consideration.