Director Network Contract Coord

Company: Gameinstitute Community
Location: Miami
Posted on: March 4, 2025

Job Description:

Location: Alternate locations may be considered. This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our PulsePoint locations.The Director Network Contract Coord is responsible for managing and negotiating contracts with large home health (HH), durable medical equipment (DME), large vendors and aggregators to ensure a home health agency can provide services to patients while maintaining financial viability; their key duties include identifying the best contract payment model, negotiating contract terms, monitoring compliance with contract agreements, and minimizing year over year units costs for Carelon Medical Benefits Management businesses.How you will make an impact:

• Lead contract negotiations with home health (HH), durable medical equipment (DME), and other ancillary providers and vendors which include negotiating reimbursement rates, service offerings, utilization management, and quality metrics.
• Develop and maintain strong relationships with key decision-makers at payer organizations to understand their needs and advocate effectively for the agency's interests.
• Analyze contract terms to assess financial implications, identify potential risks, and ensure compliance with regulatory requirements by staying updated on industry trends, payer regulations, and market dynamics to identify new contracting opportunities.
• Develop financial projections and forecasts based on potential contract agreements to evaluate their impact on the agency's revenue and profitability.
• Regularly monitor contract performance, including utilization rates, reimbursement levels, and adherence to contract terms.
• Collaborate with clinical teams to identify areas for quality improvement related to contract requirements and patient care.
• Lead and mentor a team of contract specialists responsible for managing specific payer relationships and contracts, ensuring the contract administration goals are obtained and maintained.
• Direct the contract administration policies and standards, providing strategic oversight of the contract administration function within a given unit.
• Identify contract administration information needs and technologies and manage the annual operating budget within financial objectives.
• Hire, train, coach, counsel, and evaluate the performance of direct reports, supervising workflow and performance.
• Provide quality control services through the monitoring of work results and performing audits to ensure compliance with departmental policies and procedures.
• Develop and implement associate training and prepare reports to support the organization's objectives.
• May be assigned to special project work consistent with the role and dictated by the business needs.Minimum Qualifications:Requires Bachelors degree in a related field and minimum of 5 years equivalent work experience in provider contracting, or any combination of education/experience that would provide an equivalent background.Preferred Skills, Capabilities, and Experience:
• Over 5 years of experience in healthcare contracting, with direct expertise in negotiating contracts with large home health (HH) and durable medical equipment (DME) providers, as well as service vendors strongly preferred.
• Proven track record of successfully negotiating and managing provider contracts, with a comprehensive understanding of the home health and DME industry, including billing codes, reimbursement mechanisms, and the regulatory landscape strongly preferred.
• Deep knowledge of Medicare, Medicaid, and Commercial business practices related to home health, DME, and other post-acute services strongly preferred.
• Proven ability to negotiate complex contracts with payers, securing favorable terms for the agency preferred.
• Strong analytical skills for interpreting financial data and making informed decisions regarding contract profitability strongly preferred.
• Exceptional strategic thinking, decision-making, and problem-solving skills, with demonstrated adaptability preferred.
• Experience in collaborating with cross-functional teams and coordinating efforts towards common goals preferred.
• Confidence in interacting with senior management and executive-level stakeholders as a subject matter expert, with comfort in influencing decision-making preferred.
• Excellent written, oral, presentation, and interpersonal communication skills, with a proven ability to negotiate expectations between multiple parties highly preferred.
• Experience using CONGA contracting tools is preferred.
• Proficiency in Microsoft Office products, particularly in PowerPoint and Excel preferred.For candidates working in person or remotely in the below location(s), the salary* range for this specific position is $130,452 to $223,632.Locations: District of Columbia (Washington, DC); Illinois; Maryland; Minnesota; New York.In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).Elevance Health is an Equal Employment Opportunity employer and all
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Keywords: Gameinstitute Community, Miami , Director Network Contract Coord, Accounting, Auditing , Miami, Florida