Requisition #: 281983
Location: Johns Hopkins Health System,
Category: Non-Clinical Professional
Work Shift: Day Shift
Work Week: Full Time (40 hours)
Weekend Work Required: No
Date Posted: Oct. 16, 2020
Reports to the Director of Managed Care Contracting and provides general support for contract negotiations and oversees maintenance and development of the OMC’s contract management system. Will also be responsible for contract negotiations on behalf of JHHC entities. Responsibilities specific to this position will include maintaining OMC contracts including development, implementation and maintenance of an OMC Contract Management system, analyzing and summarizing pertinent contract terms for use by OMC staff and JHHC entities/departments, research related to contract negotiations, applicable laws & regulations and contractual disputes and serves as a liaison and general resource for staff at all JHM Operational Units and Senior Management levels as well as front line staff regarding Managed Care Contracts. Monitors contractual changes, amendments and assignments to existing contracts. Negotiates and executes contracts with payors. Makes strategic recommendations based on assessment of market opportunities. Represents Johns Hopkins Medical Institutions to third party payors. Assists in development of policies and procedures for contracting which meet the market demands and which are consistent with the needs of JHM stakeholders, including the Office of Johns Hopkins Physicians, JHHS, JHCP, HCGH OB/GYN, JHRP, HCGH, Suburban Hospital, Sibley Memorial Hospital, Ambulatory Surgery Centers, Home Care Group and other JHM hospital, physician and other clinical entities
Work requires a professional level of knowledge in healthcare administration or a related field. A Bachelor’s Degree in HealthCare Administration or related field is required. Equivalent years of work experience may be substituted for educational requirement. Master or J.D. a plus but not required.
Requires demonstrated experience in the managed care environment. Requires essential knowledge of health care and managed care concepts and terminology, an understanding of the breadth of clinical services provided by Johns Hopkins and the ability to effectively communicate at a highly professional level. Requires ability to interpret and negotiate contract terms. Requires knowledge of health care contract administration to include the relationship among operational units involved in executing and maintaining contracts. Requires knowledge of hospital and physician billing system and practices. Knowledge of value based contracting a plus.
Requires strong interpersonal skills to effectively interface with all levels of staff including internal and external business related associates. Requires excellent verbal and written communication skills. Must possess strong organizational skills, be very detailed orientated, have a high degree of analytical ability and problem solving skills and basic computer skills i.e. word and excel. Requires excellent independent research skills and ability to work as a team.
D.Required Licensure, Certification, Etc.:
E. Work Experience
Requires a minimum of seven years experience in a health care environment preferably in the managed care/contracting division of a health care system or contracting/provider relations division of an insurer. Experience should include contracting and knowledge of managed care concepts, billing information systems and financial modeling. Experience in performance/value based contracting a plus.
F. Machines, Tools, Equipment:
Computer, Microsoft Office Software, General Office and Communication Equipment
A. Budget Responsibility:
B. Authority/Decision Making Level:
Position responsible for initiating and distributing information for the signed managed care contracts to JHM staff. Makes decisions regarding contract and policy interpretation and implementation. Works independently with very limited supervision and prioritizes own workload.
C. Supervisory Responsibility:
This is not a supervisory position.
Uses knowledge of health plan operations, knowledge of contract requirements and critical thinking skills to make independent decisions and use problem solving abilities to resolve contractual and operational issues on a daily basis.
Understands and interprets payer contract requirements, financial, utilization and statistical reports. Understands medical claims and associated medical coding as well as having a working knowledge of the internal registration and billing systems for both hospitals and physicians. Proficient in Microsoft applications: PowerPoint, Excel and Word.
Works in a normal office environment where there are no physical discomforts due to dust, dirt, noise and the like. Work is sedentary in nature; however, some stooping, bending and walking is required. The position requires keyboard activity, filing and duplicating. Work may require some day time travel up to 30% of the work time.
Pay Grade: NL
Johns Hopkins Health System and its affiliates are drug-free workplace employers.
We are committed to providing a healthy and safe environment for our patients, visitors and staff members. The Johns Hopkins Hospital has a tobacco-free at work policy. Employees must refrain from using any tobacco products during their work shifts — including while at lunch or on breaks, and whether they are on or off campus.
Johns Hopkins Health System and its affiliates are an Equal Opportunity / Affirmative Action employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.