Careers - VEP Healthcare

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Contact

  • VEP Healthcare
  • 1001 Galaxy Way, Ste 400
  • Concord, CA 94520

  • Phone: 925-225-5837

Payor Contracting Manager
Administration
Concord, CA
JO-1909-2284
9/11/2019

Job Summary:
Manage the process for health plan and provider contracting for multiple lines of business to include Medicare Advantage, Medi-Cal, Medic-Aid, Commercial HMO, and Commercial PPO. Key responsibilities include analyzing, negotiating, implementing and monitoring health plan, physician group, hospital and ancillary provider contract terms across multiple lines of business to include Medicare Advantage, Medi-Cal, Medic-Aid, Commercial HMO, and Commercial PPO.

Essential Job Functions:
  • Analyzes, recommends and takes lead in negotiating and implementing rates and terms for health plan, ancillary, hospital and physician contract terms, ensuring that key operational and financial objectives are met.
  • Utilizes both internal and external data sources to maximize Hill Physicians’ financial and operational performance. Analyzes and audits financial terms in partnership with other departments to monitor performance and ensure compliance with contract terms, including health plan revenue and shared risk analyses.
  • Supports the Vice President of Clinical Services by providing information and support required to develop and implement policies, processes and procedures necessary to achieve strategic objectives.
  • Analyzes and drafts contract language, working with legal counsel as necessary.
  • Acts as department liaison between other VEP Healthcare departments and the Executive Leadership team to identify problem patterns, implementing new processes, ensuring compliance with contract terms, and achieving improved communications and other processes between VEP Healthcare, the front-line medical providers, and contracted third-party vendors as needed. Responsible for communicating such information to all departments within Hill Physicians.
  • Support the Vice President of Clinical Services, in generating reports and performing special projects.
  • Identifies opportunities for cost savings or improved contract terms throughout the network.

JOB QUALIFICATIONS:
  • Exceptional written and verbal communication skills, including public speaking and facilitation skills. Strong desktop application skills including Word, Excel, and PowerPoint, database management skills a plus.
  • Ability to identify and define work process issues and work collaboratively to find solutions.
  • Strong demonstrated financial analysis and auditing skills.
  • Effective at working independently and in partnership with key internal stakeholders. Able to develop constructive and credible relationships with external business partners.
  • Must be able to successfully and simultaneously manage multiple projects and deadlines.

Education and Work Experience Requirements:
  • Bachelor’s degree required; Masters preferred
 
  • Minimum five (5) years’ experience in managed care, with experience in capitated contract environments. Must have working knowledge of provider & health plan contract operations.
  • Managerial experience desired

Would you like to apply to this job?

Apply for the Payor Contracting Manager position


1001 Galaxy Way, Suite 400, Concord, CA 94520 | Phone: (925) 225-5837 | Main Fax: (925) 225-5838

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