Provider Contracts Manager

The Provider Contracts Manager, reporting to the Manager of Provider Services Operations, is responsible for managing contracting activities for the HPSM provider network. This includes drafting and negotiating contracts, maintaining a contracts database, ensuring compliance with regulatory requirements, and analyzing rate scenarios. The role involves collaborating with internal and external stakeholders, supporting audit activities, and providing recommendations for system improvements. Required qualifications include a bachelor’s degree in a relevant field and at least two (2) years of experience in healthcare contract coordination, along with knowledge of Medicare and Medicaid regulations, health plan reimbursement, and proficiency in Microsoft Office applications and CRM tools.

Position overview

• Draft, review and negotiate Memorandums of Understanding (MOUs), Letters of Agreement (LOAs), and contract language with providers and internal stakeholders, ensuring that regulatory and contracting requirements are met.
• Act as primary point of contact for the interpretation of provider contracts MOUs, and LOAs; provide guidance and education on contract requirements and support the resolution of provider disputes related to contractual requirements.
• Conduct provider outreach to non-contracted providers who have frequent LOAs with HPSM, to initiate contracting.
• Collaborate with business owners to develop provider contracts and/ or MOU/LOAs.
• Maintain all provider contract templates, MOUs, and LOAs as assigned; execute contract maintenance processes including contract renewals, amendments, and terminations.
• Provide recommendations on improving provider contract management systems and implement improvements to existing contract management systems.
• Propose contract revisions to mitigate risks and improve the clarity of contract requirements.
• Work collaboratively with departmental staff and other agencies/participants involved in the contract development and approval process.
• Serve as department resource on the development and implementation of relevant document management systems including a provider contract database; ensure that the database is maintained and updated with ongoing improvements.
• Support internal and external stakeholder meetings related to provider contract language, provider payment, and other regulatory requirements.
• Support audit activities and regulatory reports for NCQA, DMHC, DHCS, and CMS as needed.

Requirements

These are the qualifications typically needed to succeed in this position. However, you don’t need to meet every requirement to apply. 

Education and experience

• Bachelor's degree in business, healthcare policy/administration, or a related field.
• Minimum of two (2) years’ experience in health care or health insurance contract coordination.
• Experience developing provider contract strategies based on cost-benefit analysis, research, and competitive analysis.

Knowledge of:

• Contract writing.
• Medicare and Medicaid regulations and requirements.
• Managed Medicare and Managed Medicaid operations.
• Health plan reimbursement, as well as provider billing and payment processes.
• Medicaid and Medicare reimbursement methodologies, fee schedule development, utilizing financial models and analysis in developing provider payment rates and risk-sharing arrangements, and knowledge of claims processing systems and other health plan managed care systems.
• Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, Access and PowerPoint, and other CRM tools.

Ability to:

• Work cooperatively with others.
• Analyze regulatory language and translate requirements into contract language.
• Communicate effectively, both verbally and in writing.
• Adapt to changes in requirements/priorities for daily and specialized tasks.
• Communicate, interact, and collaborate effectively with both internal and external customers.
• Analyze issues and make appropriate decisions.
• Perform work with meticulous attention to detail.
• Organize and prioritize tasks and deliver results within set deadlines.
• Learn how to use new applications and information systems as needed.

Benefits

Excellent benefits package includes:

• HPSM-paid premiums for employee’s medical, dental and vision coverage (employee pays 10% of each dependent’s premiums)
• Fully paid life, AD&D and LTD insurance
• Retirement plan (HPSM contributes equivalent of 10% of annual compensation)
• 12 paid holidays a year, 12 paid sick days a year and paid vacation starting at 16 days a year
• Tuition reimbursement plan
• Employee wellness program

It is HPSM's policy to provide equal employment opportunity for all applicants and employees.  HPSM does not unlawfully discriminate based on race, religion, color, national origin, ancestry, physical disability, mental disability, medical condition, marital status, sex, age, sexual orientation, veteran status, registered domestic partner status, genetic information, gender, gender identity, gender expression, or any other characteristic protected by applicable federal, state, or local law.  HPSM also prohibits discrimination based on the perception that an applicant or employee has any of those characteristics or is associated with a person who has or is perceived to have any of those characteristics.