Job Details

Inspire Health. Serve With Compassion. Be The Difference.

Reviews, negotiates, and manages contracts for ancillary services including but not limited to Ambulatory Surgery Center, Urgent Care, imaging, and infusion. Requires strong financial, analytical, contract language knowledge, andnegotiation skills to support the strategic business goals of the organization.

Essential Functions

• All team members are expected to be knowledgeable and compliant with Prisma Health's values: Inspire health. Serve with compassion. Be the difference.
• Negotiates and maintains contracts including but not limited to all ancillary services required by all payer types in which Prisma Health participates. Contributes to the execution of strategic JV initiatives aligned with the organization's goals.
• Conducts market and competitive data analysis to inform key decision-making and positioning strategies. Monitors and reports on key contractual financial performance indicators. Possesses a strong understanding of healthcare, contract law, and market factors to ensure network compliance, cost savings, and high-quality patient care within specified time frames in collaboration with key stakeholders.
• Performs detailed analyses of the financial and operational impact of procedural changes implemented by payers. Creates and implements educational presentations for changes being implemented by Payor for organizational departments.
• Collaborates with and trains department team members in assisting with managing the processing of all ancillary payer contracts and amendments including language, reimbursement methodology review, and contracting. Conducts proactive communication, contract compliance, and educational sessions. Develops and maintains effective relationships with payers and internal customers.
• Performs other duties as assigned.

Supervisory/Management Responsibilities

• This is a non-management job that will report to a supervisor, manager, director, or executive.

Minimum Requirements

• Education - Bachelor's degree in Business or a related field. Masters degree in Finance, or Business preferred.
• Experience - Five (5) years of related experience. 5 years Ancillary Contracting experience in a contracting or provider relations role preferred.

In Lieu Of

• In lieu of the education and experience requirements noted above, the following combination of education, training and/or experience may be considered an equivalent substitution: Bachelor's Degree and eight (8) years Managed Care Systems experience in healthcare administration, health insurance, provider contracting, or a related field.

Required Certifications, Registrations, Licenses

• NA

Knowledge, Skills and Abilities

• Knowledge of the health-insurance industry, specifically managed-care contracting operations and negotiation techniques
• Knowledge of office equipment (fax/copier)
• Proficient computer skills (word processing, spreadsheets, database)
• Mathematical skills
• Understanding/experience in healthcare/nursing industry, preferably in training and implementation of contract management systems preferred

Work Shift

Day (United States of America)

Location

Prisma Health Corporate Office

Facility

7001 Corporate

Department

70019069 Managed Care Contracting

Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.