Network Contract Leader

October 12, 2024

Industry: Private

Employment Type:- Full Time

Work Hours:- 8 Hours

Locations:- USA

Full Job Description:-

What We Need:

BCBSMA has been a national leader in implementing innovative payment models like the Alternative Quality Contract and most recently announced our intent to collaborate with providers to develop incentives to reduce racial inequities in care. The Contract Leader works closely with the Director of Network Contracting to successfully execute these innovative payment models and quality incentive programs, as well as achieve unit cost trend targets. The Contract Leader is the primary negotiator for an assigned portfolio of hospital and physician organizations and is responsible for managing the end-to-end process of developing proposals, negotiating terms, and accurately drafting and finalizing contracting language and financial rates. A successful Contract Leader is analytical, has high attention to detail, and is able to communicate persuasively and effectively, both verbally and in writing.

This position is eligible for our FLEX persona.

Day-to-Day:

Lead negotiations for an assigned portfolio of contracts, which may include fee-for-service, pay-for-performance, and risk-sharing hospital and physician contracts, ensuring that both the business and financial objectives are achieved in all initiatives.
Manage all aspects of negotiations including analyzing publicly available market data and internal data, developing proposal presentations and letters, negotiating terms with providers, liaising with the legal team and other business areas to assess risks, drafting contract language and financial terms, and ensuring that final contracts are accurate and complete.
Develop rate proposals using Excel-based modeling tools and work with Actuarial to obtain all other rate and utilization analytics needed to support contract negotiations.
Ensure new contract terms and rates are successfully communicated within the organization and implemented accurately as of the contract effective date.
Work effectively with multiple departments to ensure that contracts align with our corporate strategy and are compatible with health plan operations, policies and procedures.
Contribute to the development of creative contracting strategies, reimbursement structures, networks, and approaches that will maximize BCBSMA’s competitive position and advance our corporate strategy.
Facilitate cross functional negotiation teams.

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Qualifications (Knowledge, Skills and Abilities)

Solid understanding of global, hospital and physician contract development; demonstrated negotiation of complex provider payment arrangements; demonstrated financial, analytical, and modeling abilities; demonstrated understanding of health care reimbursement methods and strategies.
Demonstrated ability to influence, negotiate, and operate collaboratively as part of a team.
Excellent written/verbal communication skills; effective presentation skills; project management and planning skills critical.
Demonstrated ability to advance initiatives and work independently.

Education/Relevant Experience:

BS/BA required; Masters preferred
5+ years demonstrated health care finance or policy experience, with 3+ years provider or payer contracting and negotiation experience preferred.