Hosp Contracting Spec II
$87,300–$119,070 year
RemoteNewark, New Jersey, United States
Job Summary
Facilitate and lead negotiations with over 32,000 provider partners across Commercial, Medicare, Medicaid, DSNP, MLTSS, and Casualty services. Manage provider file maintenance, claims stops, and new hospital implementations while analyzing technical inefficiencies in system-wide claims and configuration. Collaborate with Medical Economics and Legal to prepare rate proposals, modify contract templates for compliance, and implement value-based contracting initiatives. Ensure accurate contract loading, maintain provider contract language, and contribute to network strategy that aligns with enterprise affordability objectives. Moderate travel is required.
Required Qualifications
- High School Diploma/GED
- Bachelor degree in business, finance, accounting, health administration
- Relevant experience in lieu of degree
- Minimum of 5 years of business experience in hospital finance and/or managed care network development
- Minimum 5 years demonstrated experience in two or more with in-depth knowledge and understanding of contract finance and reimbursement methodologies including FFS, Medicare DRG and APC's, Medicaid pricing, capitation, full risk, shared savings and incentive arrangements
- Minimum of 5 years provider experience in Commercial, Medicare, Medicaid, and Value Based Programs
- Minimum of 5 years' experience in hospital finance and/or managed care network development
- Minimum of 5 years' experience in health care cost data analysis and technical document writing
- Knowledge of Principals of Health Care contracting
- Knowledge of health care industry or health insurance industry
- Knowledge of the hospital and physician communities in the state of New Jersey
- Knowledge of laws and regulations regulating insurance, HMO hospital and physician practice
- Knowledge of quality measurement approaches applied in measuring insurance, HMO, hospital and physician practice
- Proven analytical, business case and product design skills
- Proven ability to exercise sound judgment
- Proven ability to ask probing questions and obtain thorough and relevant information
- Detail oriented with strong organizational skills
- Proven ability to follow detailed instructions
- Proven problem-solving skills
- Ability to effectively present information and respond to questions from groups of managers, clients, customers
- Effective verbal and written communication skills
- Ability to work well within a team
- Moderate travel
Desired Qualifications
- Preferred Master's degree in health or business
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