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Director of Provider Contracting

Job Ref: 78423
Category: Professional
Department: PROVIDER CONTRACTING
Location: 50 Water Street, 7th Floor, New York, NY 10004
Job Type: Regular
Employment Type: Full-Time
Hire In Rate: $155,000.00
Salary Range: $155,000.00 - $170,000.00

Empower. Unite. Care.

MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

About NYC Health + Hospitals

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

The Director of Provider Contracting is responsible for contracting a comprehensive provider network. This is a highly responsible position that requires considerable experience in Health Care, participating with and overseeing a team charged with improving member, and employee experience in the pursuit of excellent service. This is an excellent opportunity for a hard-working, motivated, detail-oriented individual who understands the importance of completing tasks accurately and timely. The Director of Provider Contracting must be a highly organized, respected leader with excellent interpersonal skills who possesses a high level of energy and innovation. In addition, this individual must have excellent writing skills. Must be able to accomplish a broad range of tasks simultaneously with strong attention to deliverable timeliness. Responsibilities for this position include assisting the Senior Director of Provider Contracting with effective business relationship development, report preparation, supervision, staff development, knowledge of health plan accreditation, and regulatory compliance. In addition, this position is responsible for collaboration with other departments at MetroPlusHealth to ensure accurate and timely implementation of contracts. The position requires travel throughout the MetroPlusHealth service area. The Director of Provider Contracting is required to work effectively with various professional organizations, committees, internal departments, and external and network organizations.

Job Description

  • Oversee process of contracting physicians, medical groups, and ancillary providers.
  • Evaluate and negotiate contracts in compliance with company templates, reimbursement struct standard and other key process controls.
  • Manage unit cost budgets, target setting, performance reporting and associated financials models.
  • Forecast and plan on-going contract renewal strategy.
  • Assist with Managing the Physical and Behavioral Health Provider network; ensure adequacy; ensure payment is completive and meets regulatory guidance.
  • Draft and coordinate contract amendment mailings as needed, within regulatory and plan mandated timeframes.
  • In collaboration with the Senior Director, manage provider contracting and fee schedule.
  • Coordinate with Credentialing, Provider Maintenance, and Core Configuration units to ensure contracts are implemented efficiently, accurately, and timely.
  • Ensure agreements are following regulatory requirements.
  • Develop and maintain contracting policies and procedures.
  • Manage key contracting efforts and contracting processes.
  • Negotiate agreement language and rates and secure internal approval, approval for Corporate Affairs and SDOH as needed.
  • Ensure agreement implementation process is followed.
  • Participate and/or oversee are specific projects and annual business plan.
  • Upon agreement execution, ensure notification in made to internal and external parties.
  • Prepare progress reports and analyses as required for discussion with senior administration.
  • Implement the plans network development strategy.
  • Identify solutions to non-standard request and problems.
  • Assess customer needs and requirements.
  • Resolve contract related issues with participating providers and communicate with providers as needed.

Minimum Qualifications

  • Bachelor’s degree in Business Administration, healthcare, legal studies or related field required.
  • Minimum of 10 years or more of experience in a Health Plan environment with knowledge/experience in contracting, reimbursement, network, or provider services, and/or vendor management Health Care environment.
  • Minimum of 7 years payer experience including developing, implanting, and executing contract strategies across multiple products.
  • 7 years of demonstrated expertise in operational and contractual quality improvement strategies.
  • Deep understanding of regional health care environment and the payer/reimbursement space: ability to identify trends in healthcare that impact business and operations.
  • Experience of leading and implementing strategy and business Plans.
  • Experience with Profit & Loss accountability.
  • Demonstrated management and leadership experience with successful experience building and maintaining effective business relationships.
  • Knowledge of managed care administration and standards, regulations, and laws applicable to contracting, knowledge of business and human resources. administration principles, management techniques and the ability to direct and supervise personnel.

Professional Competencies

  • Integrity and Trust
  • Customer Service Focus
  • Functional/Technical skills
  • Written/Oral Communications