Location: Burlington, MA
Job ID: 166270-1A
Date Posted: May 3, 2021
Welcome to Shared Services, our team uses a coordinated approach to delivering administrative and operational services across Lahey. Our Shared Services colleagues leverage resources across the organization to ensure we provide high-quality, high-value care to the communities we proudly serve. The Shared Services team includes colleagues who focus on business and network development, legal services, facilities and real estate, human resources, information technology, finance, philanthropy and marketing and communications.
About the Job
The Senior Contract Specialist (Managed Care) provides departmental support for the successful negotiation and maintenance of managed care contracts between various managed care payers and Beth Israel Lahey Health Performance Network (BILHPN), Beth Israel Lahey Health (BILH) entities and other affiliated providers. Facilitates the completion and submission of payers’ requests for information for “Center of Excellence” status as well as hospital and other facility re-credentialing applications. Participates in the negotiation and implementation of payer contracts for allied and behavioral health providers and other contracts, as assigned by the Contract Manager. Also negotiates single case agreements with non-contracted payers. Assists in the maintenance of contract database and Contracting Department files of original executed contract documents.
Essential Duties & Responsibilities including but not limited to:
Participates in analyses of managed care proposals and participates in negotiation of financial terms with payers, as assigned by the Contract Manager.
Participates in review of managed care contract language with pertinent staff and legal counsel. Coordinates the contract language review/edit process of assigned contacts and negotiates modifications or terms as necessary and as directed by the Contract Manager.
Maintains working relationships with operational staff while supporting them in contract terms issue resolution with the payers.
Assists in maintenance of contract database for tracking and managing contract cycle ensuring timely and accurate data entry of assigned contracts.
Develops and/or requests and maintains reports and completes analyses as necessary to evaluate contract performance.
Files/updates Contracting Department electronic and physical files of contract documents and supporting documentation.
Provides staff support to Vice President, Contracting and Director, Contracting for projects and committees.
Negotiates directly with non-contracted payers for specific individual patient services to be provided by BILH affiliated providers.
Supports BILH’s Behavioral Health and/or Continuing Care Departments in negotiating financial and contract terms with various payers and in negotiating patient specific agreements when necessary.
Completes and submits facility re-credentialing applications from various payers as required.
Completes and submits Requests for Information to apply for/maintain BILH facilities and program’s status as Centers of Excellence with various payers
Serve as a knowledgeable resource on new and current provider contracts.
Analyze and interpret contractual, legal, regulatory and legislative provisions to ensure contracts meet business and regulatory compliance. Develop alternative approaches when appropriate.
Collaborate with other departments as well as within own department to research and resolve contractual issues.
Performs other duties as assigned, or directed, to ensure the smooth operation of the department including direct communication with patients, providers and payers related to contracts.
Bachelor's Degree in Health Administration, Business Administration or Public Health required or equivalent education and experience. Master's Degree preferred.
Licensure, Certification & Registration:
3-5 years previous experience in managed care required including at least 1-2 years in managed care contracting.
Skills, Knowledge & Abilities:
Knowledge of managed care contract terms and provisions, including fee-for-service, per diems, DRGs, carve-outs, etc.
Requires excellent interpersonal, oral, and written communication skills to work with individuals from numerous departments and different levels within and outside of the organization, as well as the ability to work collaboratively to negotiate contract terms and single case agreements.
Must have the ability to work independently and in a fast paced environment balancing multiple priorities and utilizing resources appropriately.
Proficiency in the use of PC-based computers is essential.
Must be able to work cooperatively as a team member.
In the absence of any of these skills, demonstrates the ability to be thoroughly trained to meet organizational standards.
Beth Israel Lahey Health is an integrated system providing patients with better care wherever they are. Care informed by world-class research and education. We are doctors and nurses, technicians and social workers, innovators and educators, and so many others. All with a shared vision for what healthcare can and should be. We are committed to attracting, developing and retaining top talent. We strive to create a diverse and inclusive workplace that reflects the communities in which we work and serve. With a team approach to care, we encourage learning and growth at all levels and offer competitive salaries and benefits.
Equal Opportunity Employer/Minorities/Females/Disabled/Veterans.