Contracting Specialist I- Managed Care

Johns Hopkins Health Plans is a leader in provider-sponsored health plans. If you are interested in improving how healthcare is delivered, and have a passion to be at the forefront of change, JHHP is the place to call home. YOU belong here.

What awaits you:

• Work-life balance - This is a remote role. Applicants living in MD, VA, DC, PA, DE, or FL will be given first consideration. Quarterly travel to the Hanover, MD office may be required.
• Medical, Dental, and Vision Insurance.
• 403B Savings Plan w/employer contribution.
• Paid Time off & Paid holidays.
• Employee and Dependent Tuition assistance benefits.
• Health and wellness programs and MORE!

Who you are:

Responsible for maintaining the development of provider networks that includes recruitment, negotiating complex contracts, contacting, and re-contracting of current provider network. The position is responsible for reviewing network adequacy and determining recruitment needs within all specialties, taking appropriate actions to recruit new providers to fill in gaps to meet accreditation standards and JHHP’s strategic initiatives, and negotiating within the financial parameters to gain maximum cost efficiency and support JHHP’s goals and strategic initiatives.

As a Contract Specialist II, you will be responsible for the network development and retention of a network of physicians to ensure each territory meets network adequacy and access guidelines to meet regulatory standards. Ensures contracts are priced with standard reimbursement pricing and follows JHHP’s policies and procedures to ensure accurate claims payment.

What you’ll do:

• Engage and develop JHHP contractual relationships with a wide range of behavioral health providers including psychiatrists, therapist, residential treatment facilities, and outpatient clinics.
• Lead the implementation process to ensure all contracts are loaded into the provider maintenance Systems, reporting is implemented, and contract is operational.
• Manage the post implementation process of all assigned complex contracts including behavioral health providers and /or other specialized provider types
• Manage and audit the loading and updates of pricing and reimbursement terms to ensure contract compliance and appropriate reimbursement.
• Actively work within Networks Management and is the JHHP Networks management representative to address any questions or concerns related to complex contracts.

What you’ll bring:

• 3 years prior experience in Contracting/Network Development in healthcare delivery program or insurance setting, experience in developing various reimbursement standards.
• Experience should include: Provider contracting, negotiating complex fee schedules, knowledge of managed care concepts and billing information systems.
• Requires a strong ability to negotiate high dollar reimbursement, sound knowledge of successful selling, and negotiation techniques and an awareness of healthcare contracting terms.
• Ability to negotiate provider contract fee schedules and performance guarantees.
• Strong ability to develop unique alternative reimbursement standards that are cost efficient.
• Familiarity and knowledge of managed care concepts required
• Understanding of Mental Health Parity and Addiction Equity Act (MHPAEA) and its implications on contracting.
• Knowledge of HIPAA, CMS guidelines, and state-specific Medicaid managed care requirements.
• Competence in analyzing claims, utilization trends, cost data, and competitive market rates to support contract terms.
• Ability to use data to develop pricing proposals and assess financial impacts of contracting decisions
• Excellent interpersonal, written, and verbal communication skills.

Bachelor’s degree in business management or healthcare administration or related discipline preferred. Experience can be used in lieu of education on a 2:1 basis. (8 relevant YOE=4 year degree)

Experience with alternative payment models (APMs), value-based contracting, and bundled payments in behavioral health, highly preferred

Skilled in network adequacy analysis and identifying strategic network expansion opportunities, preferred