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Join to apply for the Manager, Physician Network Contracting (Hybrid) role at 1199SEIU Benefit and Pension Funds

Join to apply for the Manager, Physician Network Contracting (Hybrid) role at 1199SEIU Benefit and Pension Funds

• Manage the activities of physician contracting which include preparing and maintaining contracts and complex contracting and negotiations for fee for service, and value-based reimbursements with providers (e.g., large physician groups)
• Draft single case Letter of Agreements and Long-term Letter of Agreements with providers and physician groups
• Develop reimbursement models and negotiate renewal agreements with large physician groups and independent provider associations (IPAs)
• Ensure timely response to provider inquiries related to contract terms and payment methodologies via email, telephone, written correspondence, and on-site/virtual meetings
• Reinforce contract terms with Physicians, internal Fund departments, escalate time sensitive issues and ensure timely communication on network updates and changes
• Facilitate review of escalated claims and evaluates contract terms and work with internal departments to obtain issue resolution within the prescribed timeframe
• Act as liaison between internal departments and ensure all contract language issues, problematic administrative terms and recommendations are tracked and issued annually prior to the contract re-negotiation period
• Manage projects including but not limited to Request for Information/Proposal, benefit changes, and other programs and initiatives as required
• Perform additional duties and projects as assigned by management
  

Requisition #:
6963
# of openings:
1
Employment Type
Full time
Position Status
Permanent
Category
Non-Bargaining
Workplace Arrangement
Hybrid
Fund
1199SEIU National Benefit Fund
Job Classification
Exempt
Responsibilities

• Manage the activities of physician contracting which include preparing and maintaining contracts and complex contracting and negotiations for fee for service, and value-based reimbursements with providers (e.g., large physician groups)
• Draft single case Letter of Agreements and Long-term Letter of Agreements with providers and physician groups
• Develop reimbursement models and negotiate renewal agreements with large physician groups and independent provider associations (IPAs)
• Ensure timely response to provider inquiries related to contract terms and payment methodologies via email, telephone, written correspondence, and on-site/virtual meetings
• Reinforce contract terms with Physicians, internal Fund departments, escalate time sensitive issues and ensure timely communication on network updates and changes
• Facilitate review of escalated claims and evaluates contract terms and work with internal departments to obtain issue resolution within the prescribed timeframe
• Act as liaison between internal departments and ensure all contract language issues, problematic administrative terms and recommendations are tracked and issued annually prior to the contract re-negotiation period
• Manage projects including but not limited to Request for Information/Proposal, benefit changes, and other programs and initiatives as required
• Perform additional duties and projects as assigned by management
  

Qualifications

• Bachelors degree in Business or Health Care Administration required; Masters degree preferred
• Minimum five (5) years of experience working in a healthcare management setting required; to include two (2) years supervisory experience required
• Proficient in Microsoft Word and Excel
• Excellent verbal, interpersonal and written skills
• Strong negotiation and influential skills and solid problem-solving skills
• Ability to travel throughout the New York metropolitan area
• Knowledge of provider contracting methodology including understanding of Accountable Care Organization (ACO) Model, Quality-Based Shared Savings Program (QSSP) and payor roles, responsibilities, and challenges
• Knowledge and thorough understanding of government regulations and requirements as they relate to physician contracting
• Ability to work in a fast-paced environment and foster positive working relationships, multi-task and meet deadlines
  

The first six months of this position will be 100% in the office for newly hired employees.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

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