• Completes contract due diligence of perspective and renewal managed care contracts, including but not limited to investigating insurance company financial status through each state's insurance departments, and similar governmental insurance monitoring offices, federal agencies, and other reputable sources that track insurance companies nationally.
• Responsible for or coordinates the distribution of or information relating to final managed care contracts to appropriate staff and software for compliance with contractual terms to aid in revenue collections
• Directs, organizes, or attends as-needed informational sessions such as onsite meetings, webinars, JOCs, and presentations for managed care executive/contracting/provider relations staff and management to assist in securing or maintaining contractual associations
• Works closely with the Corporate Legal Department by presenting negotiated contract reviews according to the current contract review policy.
• Participates in managed care forums, conferences, webinars, and education sessions presented by managed care companies
• Demonstrates willingness to be efficient and cost-effective via:
• Monitors, evaluate and analyze the current market trends of managed care.
• Monitors all aspects of managed care relationships: financial, legal, clinical performance, and reimbursement.
• Evaluate reports in a timely manner.
• Develop, monitor, and maintain contractual relationships with managed care organizations including HMOs, PPOs, government agencies, self-insured employers, etc
• Involved in regions managed care strategic planning targeting managed care contracting and renewal opportunities
• Collaborates with other disciplines regarding outcomes and interventions 
• Coordinates and/or attends team meetings

Skills: Contract Due Diligence, Information Distribution, Contract Review, Industry Engagement, Market Monitoring, Relationship Management, Report Evaluation, Performance Analysis

• Works on behalf of Refresh in the review of proposals for new and renewal contracts.
• Directs, performs, and oversees financial analysis of payer agreements, new and old.
• Presents programs and services to the contractual staff at various payor organizations, including, but not limited to, insurance companies, medical groups, employer groups, ACO’s and third-party administrators.
• Identifies clear measurable department performance objectives and facilitates the accomplishment of these objectives through assigned projects, provider relations, community relations, and activities. 
• Department's contributions to the organization's goal
• Directs and supports staff that negotiates out-of-network letters of agreement to facilitate patient care not currently covered by a managed care contract.
• Renegotiates agreements as necessary and on a timely basis.
• Maintains departmental productivity measures, reports status 
• Develops and implements department activities in a manner consistent with organization-wide programs and procedures
• Develops and implements department policies and procedures that reflect the organization's standards
• Demonstrates good public relations skills by seeking out and interacting positively with community resources
• Ensures Contract Management System is updated with most current fee schedules for contracts overseen.
• Assists with the development and marketing of new managed care contracting opportunities at the regional and local levels while coordinating with Refresh’s national initiatives.
• Serves as the information resource to other departments regarding managed care contract terms, rates, and insurance company industry updates for the region.
• Organizes and ensures the completion of managed care organizational credentialing documents, managed care participation applications, and all other approved submission of Company documentation to managed care companies as requested.
• Retrieves necessary managed care contract financial and utilization performance reports by an insurance company via the Company database and/or other resources in order to negotiate approved protective contract language and reimbursement methodologies for Company and facilities.

Skills: Financial Analysis, Contract Negotiation, Provider Relations, Project Management, Policy Development, Public Relations, Contract Management, Credentialing

• Manage the creation and maintenance of high-quality claims data analytics to monitor the cost and utilization of all enrollees of the Special Populations Program.
• Liaise with the NYC Health + Hospitals’ Data and Analytics Team to create and maintain required Tableau dashboards, reports, and other tools needed to identify and analyze claims and membership data.
• Develop infrastructure to track and monitor the primary care and care management attribution of enrollees.
• Develop and maintain claims and membership reports for participating providers, including the creation of both standardized and ad-hoc reports.
• Collaborate with NYC Health + Hospitals’ Managed Care colleagues to develop quality metric tracking and supplemental data sharing with MCO partners and participating providers.
• Work closely with the Special Populations Director of Finance to establish processes for monitoring the program’s target budget and funds flow processes.
• Work closely with the Special Populations Clinical Analytics team on supplemental data matching with Electronic Medical Record (EMR) data.
• Work in close collaboration with colleagues within the Program to clearly communicate analytic findings for diverse clinical, operational, and leadership audiences.

Skills: Claims Data Analytics, Tableau, Report Development, Data Tracking, Quality Metrics, Budget Monitoring, Data Matching, Cross-functional Collaboration

• As a member of the commercial management team, provides day-to-day leadership and management of regional payor relations and reimbursement that mirrors the adopted mission and core values of the company.
• Counterpayor objections by clearly articulating the company’s position through written correspondence.
• Responsible for understanding the medical policy landscape of the territory and developing an action plan to overcome any negative medical policy positions.
• Detailed knowledge of payor reimbursement models is required to successfully overcome payment objections.
• Thorough understanding of the various technology assessment companies used by payors to evaluate medical policy.
• Review a negative medical policy, and develop an action plan for successfully overcoming objections.
• Responsible for collaborating with senior and commercial management to drive the company reimbursement strategy to achieve and surpass sales, profitability, cash flow and business goals and objectives.
• Provides timely, accurate and complete reports on the reimbursement status of regional payor targets.
• Spearheads the development, communication and implementation of positive payor medical policies and contracts both internally and externally.
• Plans, develops, organizes, implements, directs and evaluates the region’s reimbursement function and performance.
• Participates in the development of the corporation's plans and programs as a strategic partner.
• Enhances and/or develops, implements and enforces policies and procedures of the organization by way of systems that will improve the overall operation and effectiveness of the corporation.
• Establishes credibility throughout the organization and with senior management as an effective developer of solutions to business challenges.
• Collaborates with the senior management team to develop and implement plans for the operational infrastructure of reimbursement systems, processes, and personnel designed to accommodate the rapid growth objectives of the organization.
• Acts as an advisor from the financial perspective on any payor contracts into which the Corporation may enter.
• Fosters a success-oriented, accountable environment within the company.
• Represents the firm with payor clients, healthcare policymakers, legislators, physician organizations, patient advocates, and other key stakeholders that make or influence reimbursement decisions.

Skills: Leadership, Payor Relations, Medical Policy, Reimbursement Models, Objection Handling, Strategic Planning, Reporting, Policy Development

• Oversee or direct all negotiation and contracting activities consistent with strategies, business, and financial plans.
• Develop contracting strategies for governmental contracts to ensure the best possible outcomes for facilities.
• Take charge of significant dollar and volume contract negotiations, and oversee proper support of data, information, and financial systems to be provided for beneficial negotiations.
• Negotiate contracts with payers and governmental entities on behalf of all facilities including legal language review, the proposal of rates, reimbursement methods, and review of state/federal regulations
• Lead and provide financial analysis to support contracting efforts and issue resolution including the use of PIC forecaster Models, Excel Models, and other tools available to assess contracts or revenue recovery opportunities
• Analyze and monitor financial and operational aspects of existing contracts for use in making recommendations on renewals, re-negotiations, or terminations.
• Research state and federal regulations and educate HSC departments and facilities on the impacts of these changes to reimbursement and processes.
• Manage completed contracts including dissemination of the contract to relevant parties, explanations of new items in the contract, ensure contract has been scanned, filed, and logged
• Keep up to date with government relations and the reimbursement department on state and federal changes that require negotiations for new contracts and/or mandated changes in reimbursement at facilities.
• Organize and prioritize time and schedules to maximize exposure to key customers.
• Convert current and new customer sources into a progressively growing referral and revenue base
• Educate field sales on key components of the Health Mart Atlas strategy, value proposition, programs that improve customers’ operational and clinical performance
• Provide leadership with field sales teams to influence and drive strategy to win business for Health Mart Atlas and value add solutions business.
• Work collaboratively with the Health Mart Atlas sales team to identify proactive sales opportunities within each market segment.
• Work cross-functionally within Health Mart Atlas and field sales to drive performance goals.
• Possess a thorough understanding of payor quality and utilization data.
• Work independently on field assignments and maximize opportunities to support providers on site.

Skills: Negotiation, Strategy Development, Financial Analysis, Reimbursement, Regulatory Research, Contract Management, Modeling, Government Relations

• Experience in leading contract negotiations with HMOs and commercial payers
• Solid understanding of provider health care reimbursement methodologies and payer contracting strategies including, but not limited to, fee for services, pay for performance, capitated full risk, and shared risk in Medicare, Medicaid and Commercial lines of business. 
• Experience with dialysis providers and payment methodologies strongly
• Strong comprehension of managed care contract language.
• Strong aptitude for negotiations.
• Ability to multi-task, superb attention to detail, strong organizational skill, ability to work with minimal supervision
• Ability to problem-solve and exercise good judgment in a changing environment. 
• Ability to adapt to changes in work environment, work assignments, and/or changes in priorities.
• Must possess strong leadership and credibility to garner internal resources and support to accomplish results
• Proficiency with all Microsoft applications
• Financial and analytical skills
• Excellent communication and presentation skills

Qualifications: BA in Economics with 10 Years of Experience

• Experience with using, managing, and interpreting large amounts of healthcare data.
• Attention to detail and willingness to independently and collaboratively analyze market conditions in order to execute complex and data-driven negotiations
• Ability to deliver time-pressured projects on-time and with the desired results through a structured project management (time, team, work-stream management) approach.
• Excellent written and oral communication skills, confident and impactful presenter.
• Ability to work in a matrix environment and manage a large number of matters simultaneously
• Fosters strong inter-company relationships that facilitate cross functional monitoring of payor issues
• Assisting in the development of departmental goals, executing projects to achieve these goals, and working closely with others in the department to continuously monitor department performance
• Self-directed with a strong bias for action
• Excellent customer relationship/management skills
• Demonstrated leadership and/or people management skills
• Ability to multi-task and managed multiple negotiations at the same time. 

Qualifications: BA in Marketing with 6 Years of Experience

• Strong negotiating skills
• Solid understanding of payer contracts
• Ability to build relationships with providers, external vendors/payers and employees at all levels in the organization
• Strong communication skills both verbally and written as well as an ability to present information effectively to a Senior Level audience
• Healthcare experience, preferably working with payer contracts
• Demonstration of effective leadership and management skills
• Extensive knowledge of managed care and health system financing including managed care actuarial accounting principles, and financial risk management
• Experience with programs serving ethnically diverse and low-income clients.
• Budgetary experience.
• Proficiency in Athena, Meditech, eClinicalWorks, Gmail, Microsoft Office suite including Word, Excel PowerPoint and other programs.

Qualifications: BA in Public Health with 7 Years of Experience

• Excellent project management, critical thinking, and analytical skills
• Demonstrated experience building strong positive relationships with customers and key stakeholders, both internally and externally
• Ability to manage and influence without authority and navigate a large geography
• Must be highly self-motivated, decisive, accountable, and able to use sound judgment and prioritize key issues
• Prior sales experience
• Strong knowledge of Excel
• Knowledge of retail pharmacy clinical performance
• Field experience with a national or regional sales team or inside-home office experience 
• Strong experience with presentation development and delivery
• Strong executive presence
• Strong background in payor products, reimbursement models, referral, and authorization processes.

Qualifications: BA in Business Management with 10 Years of Experience

• Ability to analyze/interpret contract language and identify risks to the company
• Prior hands-on knowledge and experience with either Model N or I-Many revenue management systems or other comparable systems used in the pharma/healthcare industry.
• Prior experience with Salesforce or other Contracts Management tools is highly desirable.
• Intermediate to Advanced MS Excel, Word, and PowerPoint skills
• Knowledge of MS Access
• Strong interpersonal, communicative, and collaboration skills, customer service commitment, and orientation to detail are critical
• Ability to plan and complete work in a fast-paced business environment independently with limited supervision across various levels and responding to tight timelines.
• Experience in pharmaceutical contract development, negotiations, analysis, and rebate administration.
• Excellent working knowledge of managed care contracting, including the fundamentals of contract design, variations in provider compensation arrangements including capitation, and a working knowledge of hospital reimbursement
• Requires experience with advanced financial and analytic models.
• Demonstrated ability to communicate effectively with physician leaders and high-level hospital administrators, in addition to excellent negotiation skills.

Qualifications: BA in Healthcare Administration with 8 Years of Experience