Easter Seals Jobs

Northern Light Health

Department: Managed Care Contracting

Position is located: Cianchette Professional Blding

Work Type: Full Time

Hours Per Week: 40.00

Work Schedule: 8:00 AM to 4:30 PM

Summary:

This position supports the policy, and practices of the Managed Care Contracting Department, collaborates with operational departments of other Northern Light Health, and is the primary contact for managed care payer contracts. This position serves in a key role to improve the overall effectiveness and performance of Managed Care contracts using policy, practices and technology platforms both internal to the Managed Care Contracting department and all Northern Light Health Organizations.

The Contract Consultant serves as an analytical and process improvement leader. It is imperative that this position has the ability to identify areas of risk related to payer contracts and the ability to work with management and interdisciplinary teams to implement process improvements to mitigate those risks. The primary responsibility of this role is to serve as an internal consultant with strong financial and healthcare business acumen as well as the ability to clearly communicate and present analyses to management. Strong communication and project management skills are required. This position will work with both internal and external clients in the areas of change management, performance monitoring, project facilitation and other analytical needs as assigned.

The Contract Consultant will support system-wide payer relationship management and negotiations with an eye on operationalizing contracts, providing training opportunities, monitoring system compliance with managed care contracts, claims issues resolution, and provider relations to both Northern Light Health membership and contracted payers in support of management. These tactics may involve the need to: gather criteria or data sets, analyze findings, design solutions, write specifications, implement new and improved processes and recommend ongoing controls and protocols. Effectiveness of this position shall be measured by assisting teams to continue to ensure the financial viability of Northern Light Health, achievement of departmental LEMs as set by leadership, assisting operational teams with interpretation and execution of payer policy changes, relationship management, customer service satisfaction, and data management of relevant tasks and measurements.

Additionally, this position will be responsible for all NLH Medicare Advantage or Managed Medicaid and Exchange products. This responsibility will include understanding all relevant statutes and regulations governing these products, educating other NLH staff, both inside and outside of the Contracting Department on relevant issues, and working with payers to negotiate and implement these agreements.

It is critical that this position be highly effective in delivering the services described below and work harmoniously with staff in the various departments across Northern Light Health. Effectiveness will be measured in terms of results, commitment to Northern Light Health and customer satisfaction (at all levels).

Responsibilities:

·Reviews and analyzes operational effectiveness of Managed Care contracts.

·Monitors contract performance and payer compliance with Managed Care contracts

·Assists with relationship management / issue resolution between payer and providers.

·Assists in providing gap analysis between actual and targeted outcomes.

·Monitors outcomes of business intelligence, decision support and communication applications

·Manages multiple priorities simultaneously

·Provides operational analysis and summarize data challenges of the customer.

·Provides support for inquiries or issues related to credentialing, reimbursement, claims processing, and other operational departments related to contract.

·Contributes to templates and communication development.

·Identifies and assists in remedying communication issues

·Collaborates on educational events to ensure access and knowledge of payer tools.

·Acts as primary contact with MA or Managed Medicaid and Exchange payers

·Understand all statutory and regulatory issues surround MA or Managed Medicaid and Exchange programs

·Provides education to analyst team regarding pertinent areas of regulation and statutory issues

·Performs other duties as assigned.

Other Information:

·Bachelor's degree required or documented, substantive progress towards achievement of undergraduate degree accepted in lieu of degree with the expectation that degree will be achieved within one year of hire.

·Five (5) or more years of progressively responsible experience in healthcare or business.

·Working knowledge of payer contracts, reimbursements, and data streams.

·Demonstrated experience in gathering, diagnosing, evaluating and developing corrective actions.

·Working knowledge of functional areas of the healthcare and contracting departments impact on such

·Excellent communications skills, both oral and written.

·Intermediate Microsoft software knowledge and ability to train/assist end-users.

·Ability to influence change.

·Flexible and able to react to ever changing priorities.

Experience with Northern Light Health Software, data and business information is preferred.

Licenses and Certifications

• Certified Specialist Managed Care (CSMC) within one (1) year of employment

Competencies and Skills

• 5+ years of relative work experience required.

• Achieves Results: Sets high standards for their own outcomes and seizes opportunities to engage others towards objectives. Consistently moves forward with direct actions in order to attain or exceed objectives. Manages their own time effectively to accomplish assigned tasks. Successfully prioritizes multiple projects and duties as needed.

• Acts Strategically: Creates effective plans that anticipate future consequences and opportunities and is able to connect the day to day operations to longer-term objectives, shifts in the industry, and system goals.

• Applies Business Acumen: Demonstrates knowledge of current and future trends that impact organizational success. Applies proven practices and business theories to get results that meet financial as well as other business goals. Recognizes opportunities for new services and products and acts accordingly, taking measured risks into consideration. Possesses a thorough knowledge of their field and independently carries out their work in accordance with professional standards of the profession.

• Behaves with Integrity and Builds Trust: Acts consistently in line with the core values, commitments and rules of conduct. Leads by example and tells the truth. Does what they say they will, when and how they say they will, or communicates an alternate plan.

• Cultivates Respect: Treats others fairly, embraces and values differences, and contributes to a culture of diversity, inclusion, empowerment and cooperation.

• Demonstrates Adaptability: Learns quickly when facing a new problem or unfamiliar task; is flexible in their approach with changing priorities and ambiguity. Manages change effectively and does not give up during adversity. Capable of changing one's behavioral style and/or views in order to attain a goal. Absorbs new information readily and puts it into practice effectively.

• Demonstrates Emotional Intelligence: Exhibits a high level of self-awareness, self-management, other awareness and relationship management. Conducts themselves in an empathic, appropriate way, with a sense of humor and stimulates a collaborative work environment. Is respectful of the attitudes, feelings, or circumstances of others and aware of the influence of their own behavior on them. Is aware of relevant social, political, system, and professional trends and developments and uses this information for the organization's benefit.

• Develops Self and Others: Takes responsibility for engaging in professional self-development activities and programs. Strives to gain insight into their own values, strengths and weaknesses, interests and ambitions and takes action in order to enhance competencies and skills when possible. As a leader, encourages and guides employees towards growth opportunities to enhance performance and help them reach goals. Reviews and analyzes employees' strengths and weaknesses to distinguish their talents and development needs, and to ensure they are enhanced appropriately.

• Effectively Communicates: Listens, speaks and writes appropriately, using clear language. Communication methods are fitting to the message(s), audience, and situation and follow-ups are regular and timely. Shows that important (non-) verbal information is absorbed and understood and asks further questions to clarify when necessary. Expresses ideas and views clearly to others and has ability to adjust use of language to the audiences' level.

• Exercises Sound Judgment & Decision Making: Understands and processes complex information, which allows for appropriate and accountable conclusions. Does not react too quickly or slowly. Balances facts, goals, and potential approaches taking the appropriate criteria into account. Makes active decisions and commits oneself by communicating confidently and respectfully.

• Fosters Accountability: Creates and participates in a work environment where people hold themselves and others accountable for processes, results and behaviors. Takes appropriate ownership not only of successes but also mistakes and works to correct them in a timely manner. Demonstrates understanding that we all work as a team and the quality and timeliness of work impacts everyone involved.

• Fosters Innovation: Employs and encourages the use of meaningful creativity in solving challenges. Proactively identifies opportunities and uses new approaches to enhance processes, systems and services. When appropriate, suggests or initiates new strategies, products, services, and markets.

• Influences and Inspires: Builds enthusiasm and commitment among others to move in a desired direction and models it personally. Creates a compelling vision of success that motivates workplace initiative and energizes others to follow. Provides direction and guidance to encourage cooperation between team members in order to attain an objective. Has the ability to appropriately influence others' actions and decisions with and without express authority.

• Practices Compassion: Exhibits genuine care for people and is available and ready to help; displays a deep awareness of and strong willingness to relieve the suffering of others.

• Resolves Conflict: Promptly acts to find alternatives/solutions when team members disagree. Addresses issues in a direct, honest, and appropriate manner. Handles conflicting interests diplomatically and helps to solve them. Transforms difficult situations into teachable moments using respect and accountability.

• Seeks Process Improvement & Applies System Thinking: Possesses and gains insight into situations, problems and processes. Understands the interconnection between organizational elements. Deconstructs problems and systematically investigates the various components. Considers the impact of actions on the entire process/system. Detects problems and opportunities, recognizes important information, and links various data to trace potential causes and relevant details.

• Serves Others: Strives to understand, meet and exceed the expectations and requirements of internal and external customers which may include the people and communities in our service areas. Develops and maintains relationships, alliances and coalitions within and outside the organization and leverages them in order to obtain information, support, and promote cooperation and collaboration.

• Utilizes Resources Effectively: Understands how to get the most out of available resources and uses cost-benefit thinking in decision-making and in setting priorities. Monitors and analyzes resource usage to identify and eliminate areas of waste and maximize resources. As a leader, defines targets and provides appropriate means; oversees progress and makes adjustments when necessary. Appropriately delegates work, sets clear direction and manages workflow and time.

Education

• Required High School Diploma/General Educational Development (GED)

Working Conditions

• Work with computers, typing, reading or writing.

• Extend body and limbs to reach items.

• Lifting, moving and loading 20 to 30 pounds.

• Prolonged periods of sitting.

• Prolonged periods of standing.

• Prolonged periods of walking.

Position Contracting ConsultantLocation Req ID null