Job Description

Job Description

Job Description

Company:

MDX Hawaii

Job Location:

Hawaii (Hybrid - Remote & In-Office)

Job Title:

Contracts Manager

Pay Range:

$115,000 to $141,000 per year

This salary range is a guideline. Individual compensation can vary based on factors unique to each candidate, such as skill set, experience and qualifications.

Position Summary:

The Contract Manager develops, negotiates, and renegotiates provider contracts such as PCP, Specialist, Ancillary, Hospital, Vendor, and other contracts for all lines of business where MDX Hawaii holds contracts, including but not limited to Medicare Advantage, Commercial and other Government programs such as ACO REACH and Shared Savings Programs. Using approved contract templates the Contracts Manager is responsible for network analysis, cost structure and maintaining excellent relationships with providers and payors to include any applicable meetings. This position is responsible for managing the data management system, as it relates to contracting, to ensure accurate provider directories can be generated. They will work closely with claims to ensure providers are paid correctly and will conduct contractual review, develop new implementation tools, processes, and other duties, as assigned.

Essential Job Functions:

• Conducts negotiation, analysis and execution of provider and vendor contracts. and support of both vendor and provider contracts. This includes review, negotiation, and document retention.
• Manages the contract cycle process from start to finish, including document retention through data management tracking tools for contracts, amendments, correspondence, W-9s, templates, etc.
• Drafts and completes vendor contracting process.
• Tracks vendor and provider contacts for renewals.
• Participates in meetings and engages with internal and external staff, as required.
• Works closely with claims and configuration teams to ensure correct provider reimbursement.
• Works closely with credentialing, utilization management, clinical, provider engagement, finance and other teams as need to coordinate contract analysis and decisions.
• Manages contracting team to include training, education, and process improvement.

Required Qualifications:

1. Minimum Experience
   • 4 years contracting experience in managed care.

1. Education/Licensure:
   • Bachelor’s degree preferred. However, comparable education and work experience in related field will be considered.

1. Travel:
   • Position is Hybrid with Remote and In-Office requirements. May require travel via own vehicle to provider offices. May require travel to Neighbor Islands.

Skills and Abilities:

1. Language Skills: Strong communication skills, both written and verbal.
2. Written Skills: Ability to write materials for various audiences to explain reporting data and analytics.

1. Mathematical/Analytical Skills: Ability to work with mathematical concepts such as addition, subtraction, multiplication and division. Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations. Ability to use data analytics to create and monitor strategies and tactics is critical.

1. Reasoning Ability: Ability to apply principles of logical thinking to a wide range of practical problems.

1. Computer Skills: Excellent personal computer skills. Ability to create and maintain documents using Microsoft Office (Word, Excel, Outlook, PowerPoint). Proficiency in Excel required.

Job Tags

Similar Jobs