Payer Contract Analyst

Northern Light Health

Department: Managed Care Contracting

Position is located: Cianchette Professional Blding

Work Type: Full Time

Hours Per Week: 40.00

Work Schedule: 8:00 AM to 4:30 PM

This position can be remote/hybrid for Maine residents only as there may be instances where you are expected to come onsite for business needs.

Summary:

This position supports all aspects of payer contracting and relations working in support of leaders responsible for the strategy, negotiation, and execution of fee-for-service and value-based contracts for Northern Light Health (NLH) and all its subsidiary member organizations. Reporting to the Manager of Payer Strategy & Managed Care Operations (PSMCO), the Contract Analyst will collaborate with PSMCO leadership to identify and evaluate opportunities and recommend solutions that are both practical and innovative. The Contract Analyst, with support from the Manager, will establish, build, and maintain positive relationships with NLH’s business partners (e.g., employers) and payers to assure strategic alignment across the NLH Enterprise. This role will work closely with the Contract Consultant to provide relevant data analytics for PSMCO projects and contract negotiations as well as to support system-wide payer relationship management.

Responsibilities:

• Monitors contract performance and payer compliance with Managed Care contracts.
• Assists in providing gap analysis between actual and targeted outcomes.
• Display data, models, and presentations that support PSMCO initiatives.
• Provides support for inquiries or issues related to credentialing, reimbursement, claims processing, and other operational departments related to contract.
• Assists in the creation of and implementation of payer strategies that create a competitive payer landscape that ensures NLH enjoys a diverse payer profile over the long-term.
• Manages multiple priorities simultaneously.
• Reviews and analyzes operational effectiveness of Managed Care contracts.
• Compiles spreadsheets and manages the loading of NLH contract management tools.
• Research relevant topics such as CMS updates and industry trends as well as payer websites for financial and policy information.

Other Information:

Competencies and Skills

• 2+ years of relative work experience required.
• Achieves Results: Sets high standards for their own outcomes and seizes opportunities to engage others towards objectives. Consistently moves forward with direct actions in order to attain or exceed objectives. Manages their own time effectively to accomplish assigned tasks. Successfully prioritizes multiple projects and duties as needed.
• Applies Business Acumen: Demonstrates knowledge of current and future trends that impact organizational success. Applies proven practices and business theories to get results that meet financial as well as other business goals. Recognizes opportunities for new services and products and acts accordingly, taking measured risks into consideration. Possesses a thorough knowledge of their field and independently carries out their work in accordance with professional standards of the profession.
• Behaves with Integrity and Builds Trust: Acts consistently in line with the core values, commitments and rules of conduct. Leads by example and tells the truth. Does what they say they will, when and how they say they will, or communicates an alternate plan.
• Cultivates Respect: Treats others fairly, embraces and values differences, and contributes to a culture of diversity, inclusion, empowerment and cooperation.
• Demonstrates Adaptability: Learns quickly when facing a new problem or unfamiliar task; is flexible in their approach with changing priorities and ambiguity. Manages change effectively and does not give up during adversity. Capable of changing one's behavioral style and/or views in order to attain a goal. Absorbs new information readily and puts it into practice effectively.
• Demonstrates Emotional Intelligence: Exhibits a high level of self-awareness, self-management, other awareness and relationship management. Conducts themselves in an empathic, appropriate way, with a sense of humor and stimulates a collaborative work environment. Is respectful of the attitudes, feelings, or circumstances of others and aware of the influence of their own behavior on them. Is aware of relevant social, political, system, and professional trends and developments and uses this information for the organization's benefit.
• Effectively Communicates: Listens, speaks and writes appropriately, using clear language. Communication methods are fitting to the message(s), audience, and situation and follow-ups are regular and timely. Shows that important (non-) verbal information is absorbed and understood and asks further questions to clarify when necessary. Expresses ideas and views clearly to others and has ability to adjust use of language to the audiences' level.
• Exercises Sound Judgment & Decision Making: Understands and processes complex information, which allows for appropriate and accountable conclusions. Does not react too quickly or slowly. Balances facts, goals, and potential approaches taking the appropriate criteria into account. Makes active decisions and commits oneself by communicating confidently and respectfully.
• Fosters Accountability: Creates and participates in a work environment where people hold themselves and others accountable for processes, results and behaviors. Takes appropriate ownership not only of successes but also mistakes and works to correct them in a timely manner. Demonstrates understanding that we all work as a team and the quality and timeliness of work impacts everyone involved.
• Practices Compassion: Exhibits genuine care for people and is available and ready to help; displays a deep awareness of and strong willingness to relieve the suffering of others.
• Resolves Conflict: Promptly acts to find alternatives/solutions when team members disagree. Addresses issues in a direct, honest, and appropriate manner. Handles conflicting interests diplomatically and helps to solve them. Transforms difficult situations into teachable moments using respect and accountability .
• Seeks Process Improvement & Applies System Thinking: Possesses and gains insight into situations, problems and processes. Understands the interconnection between organizational elements. Deconstructs problems and systematically investigates the various components. Considers the impact of actions on the entire process/system. Detects problems and opportunities, recognizes important information, and links various data to trace potential causes and relevant details.
• Serves Others: Strives to understand, meet and exceed the expectations and requirements of internal and external customers which may include the people and communities in our service areas. Develops and maintains relationships, alliances and coalitions within and outside the organization and leverages them in order to obtain information, support, and promote cooperation and collaboration.
• Utilizes Resources Effectively: Understands how to get the most out of available resources and uses cost-benefit thinking in decision-making and in setting priorities. Monitors and analyzes resource usage to identify and eliminate areas of waste and maximize resources. As a leader, defines targets and provides appropriate means; oversees progress and makes adjustments when necessary. Appropriately delegates work, sets clear direction and manages workflow and time.

Education

• Required Associate's Degree

Working Conditions

• Work with computers, typing, reading or writing.
• Extend body and limbs to reach items.
• Lifting, moving and loading 20 to 30 pounds.
• Prolonged periods of sitting.
• Prolonged periods of standing.
• Prolonged periods of walking.