Compliance Contract Manager

POSITION SUMMARY: The Compliance Contract Manager: Responsible for the development, negotiation, and maintenance of all contracts for Charter Healthcare. Contracts include medical director, payor, vendor, consultant, real estate, one-time patient agreements and any other contract that might present itself from time to time. Key factors include assertively supporting the sales growth by developing new contracts with payers and expanding services with payers that have existing contracts. The position leads the entire contract process from pre-contract through post-signature phases, and closely collaborates with the sales team and internal departments to ensure staff are informed of new contracts, changes to existing contracts and updates to the medical and billing policies of the payers we serve.

REPORTS TO: VP of Regulatory Compliance

SUPERVISES: Payer Contract Specialist and Contract Assistant

QUALIFICATIONS:

Education: Bachelor’s degree is required. Master’s or Juris Doctorate degree is preferred.

Experience: A minimum of 5 years’ experience in a healthcare organization managing contracts, to include demonstrated leadership. Familiarity with operational, financial, quality assurance, and human resource procedures and regulations is a must. Payor contracting relationships is preferred.

Core Competencies: Knowledge and understanding of healthcare industry, payor relationships, legal and regulatory requirements. Exceptional and proven interpersonal skills. Excellent contract negotiation skills. Results driven and able to self-direct. Strong organizational and analytical skills. Well-developed communication skills. Demonstrated strength in computer software, e.g., Excel, Microsoft Word, PowerPoint, etc.

Other: Valid driver’s license and auto insurance.

FUNCTIONS AND RESPONSIBILITIES:

• Develop, negotiate, and maintain contracts with all contracting entities, e.g., insurance companies, MSOs, IPAs, TPAs, vendors and government programs. This includes researching territories to identify gaps with our payer base and supporting the expansion into new markets.
• Lead and manage the contracting team.
• Actively participate in establishing strategic business goals with the Leadership team.
• Assure contractual arrangements meet financial targets and legal/regulatory compliance requirements. There will be an emphasis on analyzing cost and utilization data.
• Facilitate the approval process of all contract documents from pre-contract through post-signature phases.
• Responsible for the accuracy of supporting documentation for contracts and completing documents accurately.
• Develop and maintain processes that provide timely notification of critical contract events (e.g., renewals, termination and due dates contained within the agreements).
• Maintain existing relationships with contracted providers. Ensure contractual language is kept current; evaluate fee schedule on a yearly basis to identify possible opportunities for additional covered services, medical policy changes and reimbursement.
• Coordinate and communicate contractual terms to the billing department; ensure staff is informed of changes in medical policy and binning policies.
• Conduct on-going assessments of assigned networks and make recommendations for strategic initiatives, goals, and objectives.
• Develop and maintain periodic reports on the status of all contracts.
• Assure accurate data entry of contract specifications and terms into database and completeness of all contracting processes.
• Maintain excellent written and verbal communication with all internal and external customers.
• Assist with all contracting administration and projects, as needed.
• All other duties and responsibilities as assigned.