Contract Negotiator Associate - Texas Health Huguley FWS : Job Details

Job Description - Contract Negotiator Associate (25030566)

Job Description

Contract Negotiator Associate (Job Number:25030566 )

Description

All the benefits and perks you need for you and your family:

· Benefits from Day One

· Whole Person Wellbeing Resources

· Mental Health Resources and Support

Our promise to you:

Joining AdventHealth is about being part of something bigger. It's about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

Job Location : Maitland, FL

The role you will contribute:

This position is responsible for negotiation support with top-tier and mid-level tier payer contracts as well as direct and indirect negotiation, review, and completion of assigned low-level tier payer contracts. Duties as assigned include supporting strategic managed care contracting initiatives as directed by AdventHealth leadership; managed care contract review, interpretation and analysis, negotiation, reporting, implementation for assigned low-level tier payer contracts; and assists in issue resolution across multiple entities including hospitals and/or physician practices in Florida as well as ancillary service providers owned, employed, or operated by AdventHealth. Facilitates compliance of contract terms for assigned payers by leading in strong working relationships with department staff, various hospital and provider staff, and leadership at all AdventHealth Florida regions, ancillaries, and external managed care payers. Actively participations in outstanding customer service and serves as a primary liaison for maintained relationships that are equally respectful of all. Diligently supports the business relationship and advances AdventHealth strategic and tactical objectives with each assigned payer.

The value you will bring to the team:

NEGOTIATION (10%)

· Represents AdventHealth as lead negotiator for assigned low-level tier managed care health plans in facilitating contract negotiations with AdventHealth business divisions to further AdventHealth strategic, tactical, and operational goals.

· Contributes to contract negotiations by performing research and participating in negotiation planning and development projects to support strategic alignment with contracted health plans.

· Seeks resolution to managed care issues by collecting and interpreting contract performance information (e.g. claims volumes, quality and efficiency reports, participation gap analysis, accounts receivable data, etc.) to preserve the integrity of those contracts.

· Is willing to develop proficiency in contract negotiation by reviewing and revising contract provisions to support negotiation initiatives.

· Applies negotiation services by contributing to meetings and projects, acting as a liaison for the Managed Care department in service of AdventHealth strategic initiatives.

· Supports the timely start of contract negotiation activities by compiling information through research and coordination with other Managed Care or AdventHealth departmental leaders and making recommendations as requested.

SYSTEMS (5%)

· Contributes to the contracting process by coordinating with other Managed Care teams and outside business units as applicable to identify contract implementation elements and opportunities.

· Performs research using applicable reports (e.g. financial statements, impact analyses, database systems, etc.) to effectively assist in contract negotiation and issue resolution.

· Coordinates with multiple internal teams (e.g. Contract Management, Finance, etc.) and external teams (e.g. PFS, Pre-Access, etc.) to ensure that contracting information is correct and up to date in all applicable Managed Care documentation and resources.

REGIONAL REPRESENTATION (5%)

· Contributes to the strategy development and implementation of assigned AdventHealth providers by serving as a managed care liaison to help advance the initiatives of those providers within the overall scope of AdventHealth managed care strategy.

· Contributes to the identification and resolution of contract performance issues for assigned AdventHealth providers by serving as a managed care liaison to help maintain effective relationships between those providers and contracted health plans.

· Promotes strong relationships between assigned health plans and AdventHealth providers as well as AdventHealth as an entity by effectively managing relationships between collaborative business units on either side to facilitate long term partnerships between AdventHealth and contracted health plans.

· Supports AdventHealth provider business unit and senior leadership in strategy development advancing AdventHealth initiatives by evaluating new managed care opportunities related to identified health plan strategies (e.g. strategic business decisions, publications, behavioral trends, new product lines, benefit design, etc.) to appropriately respond to perceived healthcare market changes.

DEADLINES AND TIMELINESS (15%)

· Completes tasks in a timely manner by adhering to timetables and expectations established by senior leadership, contributing to the effective adherence to AdventHealth strategic goals.

· Effectively completes assigned tasks by generally displaying a self-directed and highly motivated attitude contributing to a satisfactory work pace.

· Contributes to group-oriented tasks by participating as an engaged member in committees and workgroups to comply with the directives and expectations as assigned to the group.

· Assists coworkers within the Managed Care department by providing support and expertise relative to assigned negotiator job duties to help the timely completion of projects assigned to others.

· Maintains a willingness to adapt in response to changing priorities by effectively adjusting to new expectations and situations to contribute to changes in strategic initiatives.

COMMUNICATION (10%)

Effectively communicates with coworkers, leadership, AdventHealth as well as outside business unit leaders, and health plans through verbal and written messages establishing a clear, professional, and courteous position on behalf of AdventHealth.

Contributes to meaningful discussion by participating in meetings, including planning, scheduling, and coordinating such meetings with health plan representatives as well as AdventHealth provider staff and leadership, to maintain an appropriate and effective of communication with AdventHealth Managed Care.

Provides updates related to ongoing contract negotiations by ensuring the timely communication of updates (e.g. issues, requests for information, changes to negotiation parameters, etc.) to Managed Care leadership, AdventHealth provider staff and leadership, and health plan representatives as applicable, so that appropriate adjustments can be made to contract strategy and action.

Collaborates with the Managed Care contract administration team to provide timely notification and follow-up as appropriate to AdventHealth provider departments (e.g. Revenue Management, Medical Management, PFS, Pre-Access, etc.) and senior leadership for the purposes of advising as to parameters of contract completion, implementation, and performance.

Supports the facilitation of communication between leadership across AdventHealth providers as applicable by sharing contracting strategy and initiatives for the purpose of streamlining operational performance throughout AdventHealth.

Exercises care and respect with regards to protected health information (PHI) as well as trade secrets and proprietary information by ensuring deliberate and secure communication as appropriate to ensure the protection and safety of sensitive information.

SUPPORT (15%)

Supports the overall mission of AdventHealth through mindful and focused work in alignment with the role of the Managed Care department.

Participates in contract negotiations and other managed care projects in all payer tiers by supporting other lead negotiators to fully execute Managed Care strategic initiatives.

Adapts to changing needs by performing special projects and tasks as assigned to improve the role and function of the Managed Care department.

Effectively supports managed care teams and AdventHealth provider departments to identify, quantify, and resolve financial and operational issues related to accounts receivable, utilization management, quality assurance, billing, pre-access, care management, and other related issues through ongoing regular job duties and special projects.

Contributes to the financial goals and viability of the organization and its business units by contracting appropriate rates and terms in accordance with AdventHealth directives and market standards for the overall financial success of AdventHealth providers.

PERFORMANCE STANDARDS (10%)

Ensures that job duties and tasks are performed appropriately by adhering to applicable internal policies set forth by AdventHealth and its associated providers to further the strategic initiatives of the organization.

· Ensures that job duties and tasks are performed appropriately by abiding by all applicable rules, regulations, and laws prescribed by any authoritative governing body (e.g. State of Florida, AHCA, CMS, etc.).

· Supports ongoing managed care processes by assisting in the development of information and documents such as contract language and negotiation strategies for the purpose of enhancing performance standards in the Managed Care department.

DEVELOPMENT, EDUCATION AND TRAINING (20%)

Contributes to the professional growth and development of others by participating in managed care training and education sessions to continually improve the effectiveness of the Managed Care department.

Displays a willingness to grow and develop contracting and other healthcare skills required to perform job duties by attending training and education opportunities as they are presented to stay ahead of changes in the industry and further the strategic initiatives of the Managed Care department and AdventHealth.

Supports the education of AdventHealth leadership, departmental management, and AdventHealth multi-state peers by assisting in the development of educational materials and activities to streamline contract negotiation strategy and improve overall managed care performance.

Participates in industry advocacy groups (e.g. Florida Hospital Association) by contributing to requests for information or participation to support legislation and policy for healthcare providers as it relates to managed care.

Qualifications

The expertise and experiences you'll need to succeed:

· Associate degree or three years related experience

· 3+ years' work experience

· Strong organizational skills

· Self-motivated with the flexibility to multitask and restructure priorities in a fast-paced environment

· Professional attitude and conduct

· Word processing, spreadsheet, and database proficiency

· Proficiency with email, computer calendar, and web-based meetings and resources

· Excellent communication skills, both verbal and written

Preferred Qualifications:

· Bachelor's degree in healthcare, business, finance, communication, or related field

· Understands the basic functions of a large integrated healthcare system

· Understands key elements of a contract as well as negotiation practices and processes

· Can develop, implement, and execute research plans