Value Based Contracting Specialist
Requisition #: 416904
Location: Johns Hopkins Health Care, Hanover, MD 21076
Category: Non-Clinical Professional
Work Shift: Day Shift
Work Week: Full Time
Weekend Work Required: No
Date Posted: Sept. 23, 2021
Johns Hopkins HealthCare (JHHC) is the managed care and health services business of Johns Hopkins Medicine, one of the premier health delivery, academic, and research institutions in the United States. JHHC is a $2.5B business serving over 400,000 lives with lines of business in Medicaid, Medicare, commercial, military health, health solutions, and venture investments. JHHC has become a leader in provider-sponsored health plans and is poised for future growth.
Many organizations talk about transforming the future of healthcare, Johns Hopkins HealthCare is actually doing it. We develop innovative, analytics-driven health programs in collaboration with provider partners to drive improved quality and better health outcomes for the members and communities we serve. If you are interested in improving how healthcare is delivered, join the JHHC team.
This can be a virtual work position depending on the State of residence. Must reside in one of the following to be considered: MD, VA, FL, PA, DE or District of Columbia.
Responsible for maintaining a primary responsibility for 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 JHHC’s strategic initiatives, and negotiating within the financial parameters to gain maximum cost efficiency and support JHHC’s goals and strategic initiatives.
Negotiates complex contracts including Value based Contracts, Cost Reduction Related Contracts, “Risk” agreements, etc. Works in conjunction with analytics and the Finance team to develop financial models analyzing Value Based Contracts shared savings, Capitation, bundled pricing, and other reimbursement methodologies. Negotiates complex managed care contracts securing optimal reimbursement and driving high Quality outcomes.
Leads the implementation process to ensure all contracts are loaded into the provider maintenance Systems, reporting is implemented and contract is operational. Manages the post implementation Process of all assigned Complex Contracts.
Manages and audits the loading and updates of pricing and reimbursement terms to ensure contract compliance and appropriate reimbursement. Actively works within Networks Management and is the JHHC Networks management representative to address any questions or concerns related to complex contracts.
- Bachelor’s degree in business management or healthcare administration or related discipline preferred.
- Master’s degree preferred for Contracting Specialist III.
- Requires a strong ability to negotiate high dollar reimbursement, sound knowledge of successful selling, and negotiation techniques and an awareness of healthcare contracting terms.
- Strong ability to develop unique alternative reimbursement standards that are cost efficient.
- Familiarity and knowledge of managed care concepts beneficial.
- Maintains a full understanding of Medicare, Medicaid, and TRICARE Pricing reimbursement
- Requires strong analytical skills and the ability to develop and complete financial modeling for reimbursement.
- Requires strong interpersonal skills to effectively communicate and interact with diverse groups of physicians, office staff, and business-related associates.
- Requires strong ability to prioritize multiple initiatives and assigned tasks.
- Requires strong written and oral communication skills.
- Requires basic computer skills and familiarity with various software applications (word processing, spreadsheet, etc.).
- Successful track record negotiating physician, hospital, ancillary provider contracts. Complex negotiations with physicians, hospitals, ancillary providers. Strong contract language negotiation skills. Successful track record working with internal counsel, Quality and Compliance departments. Previous experience leading projects. Working knowledge of State of Maryland, TRICARE and CMS guidelines preferred.
Required Licensure, Certification, Etc.:
- More than five years prior experience in Contracting/Network Development in healthcare delivery program or insurance setting, experience in developing various reimbursement standards. May provide guidance or expertise to less experienced specialists.
Experience should include: Provider contracting, negotiating complex fee schedules, knowledge of managed care concepts and billing information systems. Value Based/Gain Share/Risk contracting experience preferred for Contracting Specialist III.
Machines, Tools, Equipment:
- Reliable transportation and the ability to visit multiple providers on a daily basis. PC, PC applications and general office equipment.
Johns Hopkins Health System and its affiliates are Equal Opportunity/Affirmative Action employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identity, sex, age, national origin, disability, protected veteran status, and or any other status protected by federal, state, or local law.
Johns Hopkins Medicine.