To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.
This position participates in health plan contracting and is responsible for facilitating contract analytics, implementation and ongoing contract management for assigned providers and/or programs within the health system. The position deals with external constituents, including managed care payers, third party administrators and insurance companies, as well as internal constituents within Yale New Haven Health System, including the System Business Office, Finance and clinical departments. Duties are assigned in accordance with priorities and strategies tied to payer relations, payer contracting and payment innovation.
- 1. Supports Payer Strategy and Innovation in negotiations with managed care organizations and/or insurers to obtain provider services agreements that advance the profitable growth of Yale New Haven Health System and/or Yale School of Medicine. This may include advanced professional and facility based analytics, contract modeling, and contract language review.
- 2. In conjunction with assigned leadership, facilitates internal review of operational requirements to ensure that provider agreements can be supported and that key deliverables or performance targets may be upheld. Upon receipt of proposed contract terms, performs objective data analysis to understand the impacts and makes recommendations in support of the priorities and needs of assigned provider entities.
- 3. Responsible for proactively managing timeframes for assigned deliverables, including obtaining fee schedule changes and contract term updates in a timely manner.
- 4. Works with leadership to deliver critical information concerning covered services, par providers, carve-outs and fee schedules to affected internal clients in a timely manner.
- 5. Monitors updates and changes to Payer provider manuals, including administrative, reimbursement and clinical policies. Summarizes information for internal consumption and distributes to department leadership and other internal constituents. Highlights changes that have material impact and makes recommendations for response.
- 6. Supports quality program initiatives through deliverables as assigned in coordination with department leadership
- 7. Work with leadership to assess and develop managed care opportunities to improve and solidify revenues, including evaluation of scope, plans and design steps.
- 8. Effectively communicates with internal and external stakeholders to foster positive relationships that support advancement of system needs and priorities, including advocacy in resolution of payer related payment issues.
Bachelor's Degree in business, public health, health care administration or related field required.
Minimum of three to five years of related experience in within a health care setting.
Excellent verbal and written communication skills. . Good understanding of managed care, health care payment methodologies, managed care financial models, and value based payment models. Experience in negotiation and running analytics related to assessment of utilization experience and trends, forecasting and health care contract modeling. Knowledge of unit cost, total cost and risk based terms and models. Operational understanding of finance, business office systems, and health system operations. Strong ethics, communication and teamwork skills.