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About the Role

The Contract Administrator, System Value Based Initiatives makes data-supported recommendations, supports the development of contracting strategies, and negotiates with payers. This role involves economic and risk assessments, ensuring contract implementation and performance, and preparing contract proposals. The administrator maintains strong collaborative relationships across internal departments and with payer organizations, assists in developing reporting instruments for contract performance, and develops payer profiles.

Responsibilities

Meets with representatives of payers, managed care organizations and other agencies to assist in the evaluation of current contracts or development of new contracting opportunities, with focus on value based payment.
Reviews proposals and makes data informed recommendations for internal consideration in preparation for negotiations.
Negotiates contract parameters and methodologies and prepares/presents proposals representing AMHS’s position.
Works cross functionally across AMHS to evaluate and develop proposals identifying opportunities and risks.
Presents opportunities and risks as directed.
Collaborates with Legal, Quality, and Compliance Departments and other departments across AMHS to ensure compliance and implementation capabilities.
Reviews terms and performance of each established contract portfolio; makes data informed recommendations for methodology changes including but not limited to those related to value based payment identifying opportunities and risks.
Mediates contract disputes to resolution and ensures compliance (both internally and externally) with contract provisions.
Monitors contract renewal dates to ensure appropriate review is conducted.
Coordinates with Finance and others to ensure timely/applicable contract analyses.
Reviews for risks and works collaboratively with Financial Reporting to ensure appropriate modeling.
Understands all modeling parameters and reports on such.
Responsible for contract education to various System-wide departments, including executive leadership, Finance, Billing, Quality, Clinical Departments, and Practice Administration as required.
Responds to requests for further information and follow-up as required.
Plans presentations and meetings including preparing narrative, overheads and handouts as assigned.
Ensures accurate reporting in all prepared presentations for documentation/archiving.
Monitors contract performance by independently collecting data, analyzing and completing spreadsheets to include comparative and economic assessments and reports on such.
Works collaboratively with Data Analytics to develop routine reporting instruments for AMHS.
Maintains broad knowledge of payers in the AMHS market and beyond, whether contracted or not.
Assists with gathering of current data on all major managed care organizations, including information regarding: financials, current membership, physician networks and current/future marketing plans.
Assists with the development of and prepares/presents reporting instruments for the AMHS.
Maintains the absolute confidentiality of patients and AMHS contracts.
Promotes and contributes positively to System-wide, intra-departmental and inter-departmental relationships by cooperating with the resolution of conflicts which may develop.
Performs special projects and assignments as requested by the Director or VP for Payer Contracting.
Assists with IDS Affiliate contracting processes related to payer contracting.
Maintains current knowledge in changes regarding Federal and New York State regulations of provision/reimbursement of medical services including but not limited to federal and NYS VBP Roadmaps.

Requirements

4-6 years in managed care negotiations and managed care network operations required.
1-3 years in and able to lead complex payer negotiations and mediation required.
This role may require access to information considered sensitive to Albany Med Health System, its patients, affiliates, and partners, including but not limited to HIPAA Protected Health Information and other information regulated by Federal and New York State statutes.
Workforce members are expected to ensure that access to information is based on a “need to know” and is the minimum necessary to properly perform assigned duties.
Use or disclosure shall not exceed the minimum amount of information needed to accomplish an intended purpose.
Reasonable efforts, consistent with Albany Med Health System policies and standards, shall be made to ensure that information is adequately protected from unauthorized access and modification.

Skills

Data-supported recommendations
Contracting strategies
Negotiations
Economic assessments
Risk assessments
Contract implementation
Operational performance
Contract proposals
Meeting preparation
Presentations
Organizational functions
Relationship management
Collaboration
Reporting instruments
Contract performance parameters
Profit/loss comparisons
Payer profiles
Membership analysis
Market share analysis
Financial analysis
Volume analysis
Value based payment
Federal and NYS reform
Methodology changes
Contract dispute mediation
Contract compliance
Contract renewal monitoring
Contract analysis
Financial modeling
Contract education
Data collection
Data analysis
Spreadsheet completion
Comparative assessments
Economic assessments
Routine reporting
Managed care organizations
Confidentiality
Conflict resolution
Special projects
IDS Affiliate contracting
Federal and New York State regulations
Medical services provision/reimbursement

Location

Albany, New York

Work Type

Day Shift
Hybrid

Experience Level

4-6 years
1-3 years

Education Level

Bachelor's Degree in Business and/or Health Care Administration
Master's Degree in Business and/or Health Care Administration (preferred)
Equivalent combination of relevant education and experience may be substituted as appropriate

Salary/Compensations

$77,075.00 - $119,466.00

About the Company

Albany Med Health System is an equal opportunity employer.

Equal Opportunity

Albany Med Health System is an equal opportunity employer.