Network Contract Administrator - Network Contracting
Full Time
Albuquerque, NM 87113
From $22.44 an hour
Posted
Job description
Overview:
Type of Opportunity: Full Time
FTE: 1.000000
Exempt: Yes
Work Schedule: Weekday Monday-Friday
Education:
Essential: * Bachelor Degree
Education specialization:
Essential: * Business
Responsibilities:
Learn more about our employee benefits:
https://www.phs.org/careers/employee-benefits/Pages/default.aspx
Why work at Presbyterian?
Presbyterian's story is really the story of the remarkable people who choose to work here. The hard work of our physicians, nurses, employees, board members and volunteers grew Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system that serves more than 875,000 New Mexicans.
About Presbyterian Healthcare Services
Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.
About New Mexico
Varied landscapes bring filmmakers here from around the world to capture a slice of the natural beauty New Mexicans enjoy every day. Our landscapes are as diverse as our culture - from mountains, forests, canyons, and lakes, to caverns, hot springs and sand dunes.
New Mexico offers endless recreational opportunities to explore and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it's all available among our beautiful wonders of the west.
AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.
Now hiring a Network Contract Administrator!
Working as part of the Network Contracting team, the Network Contract Administrator is responsible for drafting, reviewing, negotiating and finalizing payor contracts for the Albuquerque and regional hospital facilities, Presbyterian Medical Group, Presbyterian Home Health, and Albuquerque Ambulance in order to enhance system wide net revenue. Works closely with the Director of Contracts to analyze payor contracts and model reimbursement rates as needed. Provides direction and review for the finalization of all revenue generating agreements, including, but not limited to, clinical trials or studies, grants, sponsored awards, single case agreements, and limited services agreements. Works closely with the PHS Business Office/Revenue Management and serves as the primary liaison between PHS and payor.
Working as part of the Network Contracting team, the Network Contract Administrator is responsible for drafting, reviewing, negotiating and finalizing payor contracts for the Albuquerque and regional hospital facilities, Presbyterian Medical Group, Presbyterian Home Health, and Albuquerque Ambulance in order to enhance system wide net revenue. Works closely with the Director of Contracts to analyze payor contracts and model reimbursement rates as needed. Provides direction and review for the finalization of all revenue generating agreements, including, but not limited to, clinical trials or studies, grants, sponsored awards, single case agreements, and limited services agreements. Works closely with the PHS Business Office/Revenue Management and serves as the primary liaison between PHS and payor.
Type of Opportunity: Full Time
FTE: 1.000000
Exempt: Yes
Work Schedule: Weekday Monday-Friday
Location: Remote eligible
Qualifications:
- Bachelors degree in business administration or related health care field.
- 6 years of additional experience in hospital contracting, clinical studies, awards and grants may be substituted in lieu of degree.
- Strong proven analytical and negotiating skills required.
- Solid knowledge of managed care contract language, finance, reimbursement methodologies, hospital, home health, physician claim processing, and claims payment guidelines preferred.
- System knowledge of contract process, implementation and compliance.
- Must have strong organizational and personal computing skills
Education:
Essential: * Bachelor Degree
Education specialization:
Essential: * Business
Responsibilities:
- Responsible for reviewing and negotiating new contracts, amendments, and renewing contracts including professional, facility, clinical trials or studies, grants and/or sponsored awards, and any revenue generating agreements on behalf of the Albuquerque delivery system and the regional delivery system in order to maximize revenue.
- Manage assigned contracts to ensure their integrity and compliance with all state/federal regulations and communicate legal and compliance related implications related to contract changes to administrators, service line administrators, business office and any other department that may be impacted to ensure contract compliance.
- Assist department with preparation and distribution of managed care contract information to internal PHS departments, (e.g. Patient Accounting, Patient Access, Revenue Management, etc.) which includes the scanning and indexing of contracts into the MediTract Contract Management System for reference as needed.
- Serve as the initial liaison and interface between Presbyterian and various health plans or networks to develop and maintain positive payor relationships through the coordination of joint meetings and tracking problems and/or claims issues to reduce administrative burdens on behalf of PHS.
We offer more than the standard benefits!
Presbyterian employees gain access to a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more!
Learn more about our employee benefits:
https://www.phs.org/careers/employee-benefits/Pages/default.aspx
Why work at Presbyterian?
As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans. For our employees, we offer a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more.
Presbyterian's story is really the story of the remarkable people who choose to work here. The hard work of our physicians, nurses, employees, board members and volunteers grew Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system that serves more than 875,000 New Mexicans.
About Presbyterian Healthcare Services
Presbyterian Healthcare Services exists to improve the health of patients, members and the communities we serve. We are a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1,600 providers and nearly 4,700 nurses.
Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.
About New Mexico
New Mexico continues to grow steadily in population and features a low cost-of living.
Varied landscapes bring filmmakers here from around the world to capture a slice of the natural beauty New Mexicans enjoy every day. Our landscapes are as diverse as our culture - from mountains, forests, canyons, and lakes, to caverns, hot springs and sand dunes.
New Mexico offers endless recreational opportunities to explore and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it's all available among our beautiful wonders of the west.
AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.
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Offer Disclaimer: The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs. Compensation decisions are dependent upon the facts and circumstances of each offer. Minimum Offer: USD $22.44/Hr. Maximum Offer: USD $34.27/Hr.
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