Insurance Contract Consultant/Full Time/Hybrid

Reporting to Director or Manager, assist in the development of Contract Strategy and work directly with Payors to lead negotiation of contractual provisions and rates on behalf of HFHS Hospitals, Medical Group, Behavioral Health Services and other business units.

1. Independently evaluate and analyze contract proposals including completing initial proposal responses and reviewing/revising contract language and operational requirements. Review contracts with in house legal-council and work through contract revisions with Payors.

2. Assist in developing Value Based contracting guidelines and take lead role in negotiating Value Based contract models and other complex payor relationships.

3. Routinely monitor current contracts for appropriate rate structure, contract terms and annual renewals and/or re-negotiations and compliance with industry standards and guidelines.

4. Monitor marketplace for new contracting opportunities and make recommendations of changes to enhance HFHS contract portfolio.

5. Coordinate implementation of Payor arrangements and provide ongoing education and support throughout HFHS.

6. Collect and communicate relevant contractual requirements and issues to internal customers such as Utilization Management, Finance, Patient Billing, Administration, Legal, etc.

7. Maintain comprehensive files of HFHS contractual relationships and maintain contract information in the contract database.

8. Act as liaison between HFHS and Payors and facilitate resolution of contracting and operational issues, i.e. billing, utilization review, credentialing site visits, notification of site closures or new services.

9. Assist in the development and revision of department policies and processes.

10.Provide guidance and assist other Contract Administrators.

11.Provide System leadership and education in area(s) of expertise.

12.Perform other duties and projects as assigned