JOB SUMMARY
The primary responsibility of the Managed Care, Senior Contract Administrator position is leading, developing, and negotiating managed care agreements to ensure favorable reimbursement, alignment with organizational goals, and compliance with federal and state regulations. This role will oversee payer relationships, evaluate financial and operational performance of contracts, and collaborate across departments to support strategic initiatives related to revenue cycle, provider relations, and population health management.
EDUCATION & EXPERIENCE
Minimum Qualifications :
• Bachelor's degree.
• Seven (7) years related experience.
• Three (3) or more years of experience negotiating managed care contracts with third party payors.
Preferred Qualifications:
• Master's degree in business administration (MBA) or Health Administration (MHA).
ESSENTIAL JOB FUNCTIONS
• Lead the development, negotiation, and management of contracts with commercial and government payers, including HMOs, PPOs, ACOs, and Medicaid/Medicare Advantage plans.
• Analyze reimbursement methodologies and contract performance to ensure profitability and operational effectiveness.
• Develop and maintain strong relationships with payer representatives to facilitate contract negotiations and dispute resolution.
• Collaborate with finance, legal, revenue cycle, and clinical operations to ensure contract terms align with organizational capabilities and compliance standards.
• Monitor regulatory and market changes affecting payer contracts, providing strategic insights and recommendations.
• Develop key performance indicators (KPIs) to evaluate contract outcomes and drive data(1)informed decisions.
• Lead contract implementation efforts, including communication, education, and ongoing oversight.
• Represent the organization in payer meetings, contract review sessions, and industry forums.
• Provide leadership, mentorship, and guidance to Contract Administrators and related staff.
• Independently prepares and presents strategic, financial and operational proposals regarding payor agreements.
• Ensures contractual compliance with federal, state, and institutional requirements.
• Assists with strategic planning and business development.
Marginal or Periodic Functions:
• Adheres to internal controls and reporting structure.
• Performs related duties as required.
KNOWLEDGE/SKILLS/ABILITIES
• Excellent written and verbal skills; negotiation skills, computer proficiency (Excel and various software programs, data report writers).
• Strong interpersonal and verbal and written communication skills.
• Strong analytical and quantitative skills for the development of reimbursement proposals.
• Strong knowledge of healthcare reimbursement models, contract terms, and regulatory
compliance.
• Knowledgeable of professional and hospital physician service compensation models issues and
experience with fee schedule, case rate, per diem, and capitation reimbursement.
• Exceptional negotiation, communication, and relationship management skills.
• Proficiency in data analysis, contract modeling, and financial forecasting.
• Knowledgeable of patient accounting tasks including billing, collections, and reimbursement analysis.
• Strategic thinker with the ability to influence cross-functional teams.
• Familiarity with tools such as Microsoft Excel, contract management software, and healthcare data systems (e.g., Epic, etc.).
WORKING ENVIRONMENT/EQUIPMENT
Hybrid or on-site work options available, depending on organizational policy and at leader discretion. May require occasional travel to payer offices or industry meetings
Salary Range:
Actual salary commensurate with experience or range if discussed and approved by the hiring authority.
Equal Employment Opportunity
UTMB Health strives to provide equal opportunity employment without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, genetic information, disability, veteran status, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. As a Federal Contractor, UTMB Health takes affirmative action to hire and advance protected veterans and individuals with disabilities.
