Providence Health & Services Contracting Manager in Burbank, California
Providence St. Joseph Health is calling a Contracting Manager to our location in Irvine, CA.
This is a hybrid position working remotely with occasional in-office attendance
We are seeking a Contracting Manager who will be responsible for leading or participating as a team member in negotiations with Payors for acceptable reimbursement terms and contract language for all entities within the continuum of care (i.e. hospitals, physician organizations, home health and hospice services) within the applicable PH&S Region (the Region) for the payors assigned to them. Payors include the revenue primarily associated with Commercial, Medicare Advantage, and managed Medicaid products. This includes development of negotiation strategy and securing acceptable terms, problem resolution, and obtaining applicable support of leaders within the Service Area, Regional, System, and/or with strategic partners, such as ACO's and Joint Ventures.
This position is responsible for developing and maintaining positive working relationships between payors and the Providence organization. Acts as liaison between Health Plan's, Physician Group's, and other related payor organizations to ensure all aspects of payor relationships are managed effectively. Works with applicable leadership to respond to opportunities for improvement in contract terms, rates and structure. Communicates and educates applicable staff regarding key aspects of new and modified payor contracts and Health Insurance products.
This position reports to the Regional Vice President, Payer Contracting CA and must establish effective working relationships with a variety of persons at the system level, the Region, and individual ministries.
Successful accomplishment of the Primary Duties of this position will depend upon establishing and maintaining effective working relationships with a variety of persons. The position will work closely with external parties including Health Plan contracting staff, as well as internal parties including Contracting, Finance, and Accountable Care Services. In addition, this position requires the ability to establish effective working relationships with consultants and peers in other facilities to stay abreast of market and industry trends.
The incumbent performs all duties in a manner that promotes Providence mission, values, and philosophy. In all aspects, he/she serves as a role model for the values and mission of the organization.
In this position you will have the following responsibilities:
Conducts negotiations for Providence with payors as assigned and completes contracting process in a timely manner in accordance with Providence contracting principles, organizational policies and procedures, and consistent with the Mission of PSJH.
Maintains positive professional relationships with payor representatives. Responsible for asking and answering questions concerning contractual agreements and to resolve differences in understanding.
Develops reimbursement strategies to maintain effective payor relationships, working closely with Contract Compliance/Reimbursement Auditing, Contract Analytics, Revenue Cycle, and applicable leadership.
Responsible for contract negotiations for Providence affiliated facilities as assigned, including acute and sub-acute facilities, Behavioral Health and Chemical Dependency facilities, Physician services, Ancillary services, Home Health Services, and Hospice.
Communicates effectively with internal constituents on reimbursement strategies, mechanisms to improve payor compliance, and to communicate status and outcomes of negotiations.
Demonstrates working knowledge of payor contracts and understanding of implications of contract changes
Keeps current with market trends and industry news including communication to appropriate organization-wide audiences.
Coordinates the finalization of Letter of Agreement/Memorandum of Understanding with Payors as needed.
Uses critical thinking skills to ensure the negotiations result in outcomes that are both financially and operationally beneficial.
Assists with the development of revenue projections by payor for annual budgeting and long range plans.
Participates in hospital/medical group, ASC and staff committee meetings as required.
Maintains confidentiality of sensitive information at all times.
Other special projects and duties as assigned
Prioritizes and Manages multiple initiatives in a fast paced, changing environment
Maintains morale and prioritizes being a team player
MAnages multiple contract negotiations and initiatives simultaneously
Established and maintains positive working relationships with a variety of persons, internally and externally.
Required qualifications for this position include:
Bachelor's Degree in Business Administration, Healthcare Administration, Finance, Accounting or equivalent education/experience.
4 years experience in Contract Negotiations, Financial Management, or Related Field.
About the department you will serve.
Providence Shared Services provides a variety of functional and system support services for our Providence family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise.
We offer comprehensive, best-in-class benefits to our caregivers. For more information, visit
As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Non-Clinical Lead/Supervisor/Manager
Req ID: 311995