The Contract Associate is a highly visible position responsible for negotiating terms and conditions of new and existing contracts at the PACE Organization of Rhode Island. The Contract Associate must possess the ability to develop and maintain sound relationships with vendors; analyze all aspects of PACE-RI contracts, including finance terms; and research health care quality measurement goals. The Contract Associate must be able to successfully coordinate work with contracted providers, the PACE finance team, and clinical staff to finalize contracts. Additionally, the Contract Associate must be able to prepare and negotiate innovative contracting terms that result in high quality care and outcomes for PACE-RI participants. Staying abreast of best practices and developments appropriate for PACE-RI is a critical success factor for this position.
- Seek and negotiate appropriate contracts using information and support from senior management.
- Leads the negotiation of complex sensitive/high dollar volume contracts. Manages negotiations against established budget targets and contract negotiations in a timely fashion to meet corporate deadlines.
- Engages in negotiations using highly professional tactics, strong communication skills, and data driven information while representing the organization well.
- Maintains and updates relationships with key contract provider representatives with a high degree of independence.
- Develops and utilizes contracting and payment strategies and administrative policies and procedures.
- Participates in staff education and ensures that necessary staff have up to date information regarding procedures on contracts and policies.
Develops administrative policies and procedures surrounding contracting to ensure PACE-RI is following state and federal regulations.
- Prepares management reports to summarize status of contract negotiations and provides information to aid in management decision making.
- Analyzes complex data in conjunction with finance. Interprets contracting and financial data for providers.
- Performs regular check of OIG website.
- Completes quarterly audit on claims data to ensure consistency with contracting terms.
- Ensures contracts and payment terms are negotiated in accordance with established contract administration policies and procedures, including regulatory requirements and updated contract terminology.
- Ensures that contracts are easily accessible to staff, readily available, and up to date with relevant and accurate information.
- Develops and maintains a contract management system that includes expiration dates, termination dates and other relevant deadlines.
- Address vendor complaints by routing the complaint to the appropriate department and providing appropriate follow up to successful completion. Tracks complaints.
- Works with Quality & Compliance on developing and implementing a coordinated contract management program ensuring compliance.
Monitors the contract calendar to ensure contracts are current; notifies CEO and CFO when renewals are needed.
- Ensures contracts with external vendors and partners are up to date, current, and in compliance with CMS and State regulations as they pertain to PACE-RI and adult day care.
- Defines business problems and opportunities for providers and identifies strategies and tactics to provide solutions as well as to maximize the value of provider contracts to the organization.
- Oversees PACE-RI compliance with state, federal, and accreditation standards and ensures that all contracts are current with regulations.
Leads the Contract Committee and serves as a resource for PACE-RI corporate compliance questions and concerns.
- Assists in the preparation of appeals and responses to denials from third party payers.
- Bachelor’s Degree
- 3+ years of related work experience
- Knowledge of complex payment methodologies, coding and reimbursement standards, contract language standards, contract compliance issues, claims processing operations, medical management practices, quality standards, fraud waste and abuse, and clinical initiatives that impact provider performance.
- Strong ability to lead cross-functional teams.
- Excellent communication and interpersonal skills (internal/external).
- Ability to work across systems and functions to facilitate solutions and capabilities development.
- Ability to research, analyze, and interpret key information and market benchmarks.
- Positive thinker/self-starter.
- Skillful negotiator, ability to influence internal and external customers.