Dir Provider Network & Contract Analysis Job in Virginia Beach 23464, Virginia Us
Summary:
Direct the activities of the Medical Finance contracting area, especially as it relates to provider contracting, new product development, contract profitability, and special analyses. Ensure timely, accurate, and complete contract analyses that support the Networks' strategic goals and financial cost targets. Serve as liaison with corporate and plans on statistical analyses, strategic contract planing, budget analyses, and decision management. Identify and recommend actions which will enhance the profitability and value of the organization.
Responsibilities:
Responsible for provider contract analysis and providing feedback to Plan management in support of contract negotiations.
Manages analytical work in conjunction with other Medical Finance resources to ensure accurate and timely delivery of work product to the markets.
Coordinates contract strategy formulation in Local Market(s) through enhancement of contracting guidelines (preferred terms, best practices, etc.) and maintenance of contracting databases (reimbursement methodologies, competitive analyses, etc.).
Directs the analytical review and determines the profitability impact of provider contract proposals including identifying utilization impacts and medical earning improvements consistent with company goals, as appropriate.
Coordinate/direct the development, maintenance, and enhancement mechanisms to track, report, and provide feedback on contracting initiatives as they relate to the entire market(s).
Coordinate reporting in areas of provider performance, cost management, and budget variance analysis.
Coordinate/conducts analyses of medical costs versus expense and is proactive in recommending changes for earnings improvement.
Coordinate detailed financial support to all functional areas relative to contracting, which includes Local Markets, Legal, Business Control, Network Support, and Network Development
Oversee ongoing analysis and evaluation of fee schedules, benefit design impact, and contract financial terms for existing, expansion and new market health plans and providers.
Coordinate analysis of business opportunity markets and performs preparatory work for ensuring all cost items are reviewed and comparative data is prepared.
Coordinates resources for analyses with other Medical Finance Directors and staff members. Reviews and updates necessary material to keep senior management and health plan staff aware of expense exposures in contracting arena.
Ensures timely review and coordination with plans.
Ensures proper staffing levels, including but not limited to, hiring, training, managing, and evaluating.
Supervises the development and maintenance of contracting tools for use by Plan contract negotiators and Medical Finance Managers (Ratesheets, Financial Models, etc.)
Works with other home office departments to ensure all reimbursement methodologies and best practices can be administered in the most efficient manner possible.
Performs other analysis or duties as assigned or requested.
Qualifications:
EDUCATION AND EXPERIENCE:
Bachelors degree in business, finance, healthcare or related field.
3-5 years financial and statistical experience in medical expense and provider contracting analysis with at least 1 year of supervisory experience.
CERTIFICATION AND LICENSURE:
CPA or advanced degree preferred.
Knowledge and Skills:
Proficient with window based environment, particularly Microsoft Excel (or LOTUS 123); Microsoft Access, Ingenix, or Hummingbird BI/Query.
Strong analytical and organizational skills.
Previous HMO/Managed Care Industry experience required.
Appreciation of cultural diversity and sensitivity towards target population.