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Neighborhood Health Plan of Rhode Island · 2 weeks ago

Senior Contract Administrator

Smithfield, RI

Full-time, Contract

Onsite

Senior Level

$72K/yr - $94K/yr

5+ years exp

Neighborhood Health Plan of Rhode Island is seeking a Senior Contract Administrator who will be responsible for the end-to-end contracting process, emphasizing complex negotiations. The role involves developing negotiation strategies, monitoring contract terms, and ensuring compliance with managed care requirements.

Health CareMedicalNon Profit

H1B Sponsor Likely

Responsibilities

Responsible for complex, high profile negotiations, including the development, proposal and implementation of contractual terms as approved

Leads negotiations to completion and execute contractual relationships to align with specific corporate and department initiatives, strategic goals and objectives. Responsible for the accuracy of all contract and rate proposals and final contracts. Ensuring reimbursement is accurately defined, communicated and configured while maintaining network adequacy and member access to care standards and all Plan contractual requirements

Monitoring of contractual requirements through the ongoing management of contract terms including claims system configuration, contract oversight and adherence to all managed care health plan requirements

Assists in the development of the vision and strategy for the department and assigned functions including the identification, recommendation and recruitment of providers

Cultivates strong business relationships internally and externally

Ensures that providers receive appropriate and timely responses

Identifies and implements medical expense savings opportunities

Leads and collaborates departmentally and cross-organizationally in the development and planning of provider contracting initiatives and efficient business processes including recommending modifications to policy and procedures, processes, workflows and communication strategies

Provides assistance and mentorship to the Contract Administrator and support in the absence of the Manager

Provides reporting to internal and external parties

Represents the organization in appropriate internal and external committees and meetings and facilitate internal and external meetings, as required

Serves as the lead subject matter expert ensuring optimal efficiency in area of responsibility

Understands, proposes and implements various industry standard reimbursement methodologies as approved

Works collaboratively with provider relations to understand operational issues, providing assistance in the satisfactory resolutions as needed

Maintains professional growth and development

Works on special projects and other duties as assigned

Responsible for complying with Neighborhoods Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies and procedures as it applies to individual job duties, the department, and the Company. This position must exercise due diligence to prevent, detect and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents

Qualification

Contract negotiationManaged care experienceContract developmentFinancial analysisMicrosoft OfficeReimbursement methodologiesData analysisHealth insurance knowledgeCustomer service skillsPublic relationsInterpersonal skillsProject managementPresentation skills

Required

Bachelors degree in Health Administration, Business Administration, Public Health or a related field or an equivalent amount of education and experience

Five (5)+ years experience with a managed care organization or a health care related organization (e.g. HMO, Medicaid, Medicare)

Three (3)+ years experience with commercial, Medicaid or Medicare contracting and reimbursement

Three (3)+ years experience with facility, professional, and/or ancillary contracting

Ability to travel including reliable transportation. If using personal vehicle, must have current, valid drivers license and proof of insurance

Intermediate to Advanced skills in Microsoft Office (Word, Excel, PowerPoint, Outlook)

Demonstrated understanding and experience in contract development, negotiation, financial analysis, data analysis, provider reimbursement mechanisms, contract term implementation and maintenance of contractual terms

Ability to maintain confidentiality

Ability to manage data and processes in multiple platforms

Ability to manage multiple projects simultaneously

Ability to take direction and function within a team

Ability to work cross-organizationally to achieve the goals of the company and department

Demonstrated ability to successfully prioritize and organize own work to meet deadlines

Demonstrated experience speaking with the provider community, listening to grievances and communicating solutions with good follow-through skills

Demonstrated understanding of contractual language, health care delivery system, health insurance; insurance laws and regulations, including Medicare and Medicaid policies; claims processing; managed care principals, medical and insurance terminology and procedure and diagnostic codes

Excellent written and strong business communication and customer service skills (written and verbal) public relations, presentation and facilitation skills. Proven organizational skills and attention to detail

Knowledge of CMS, Federal and State laws and regulations and other applicable industry standards and benchmarks

Strong interpersonal skills; builds building high quality relationships internally and externally through actively networking

Working knowledge of facility reimbursement methodologies including per diem, case rate, bundled payments, and Prospective Payment System (PPS), including Diagnosis-Related Groups (DRG), Ambulatory Payment Classification (APC), Ambulatory Surgery Center (ASC), Resource Utilization Group (RUGs)

Working knowledge of facility contracting, including hospital, nursing facility, assisted living facility, adult day health care contracting

Preferred

Experience in an Accountable Care Organization (ACO)

Experience in Cognos

Experience in MedInsight

Experience in SharePoint

Knowledge of Quality Improvement Processes (e.g. Lean, Six Sigma)

Ability to quickly process large amounts of information, connect and integrate data into new solutions or a better understanding of problems, and identify weakness contracts or strategies

Has ambition that is appropriately displayed through the quality of their work. Individual is driven by a strong internal desire to have impact and influence in the organization

Experience in delegated entity oversight

Company

Neighborhood Health Plan of Rhode Island

Neighborhood Health Plan of Rhode Island offers nationally-recognized, high-quality health care for 185,000 Rhode Islanders.

Founded in 1993

Providence, Rhode Island, USA

201-500 employees

https://www.nhpri.org

H1B Sponsorship

Neighborhood Health Plan of Rhode Island has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2025 (1)

2024 (7)

2023 (1)

2022 (3)

2021 (4)

2020 (4)