Assistant Director of Hospital-Physician Contracts & Provider Contract Specialists

The University of Illinois Hospital & Clinics (UI Health) is seeking a full-time Assistant Director of Hospital-Physician Contracts & Provider Contract Specialists to join their team. The Assistant Director provides analytical support for contracting and provider network initiatives for assigned markets. This role oversees all provider contracts. This position serves as an internal liaison between the College of Medicine, the University of Illinois Hospital and external Managed Care related stakeholders. Accountable for providing financial analysis of provider payment terms to support medical cost review for the Finance leadership teams. Evaluates and creates financial analysis of contracts and contract profitability, audits and generates reports and executes appropriate action. Performs provider-level financial analysis. Maintains provider and facility contract information for new updates and renewals. Develops, implements and maintains policy and procedures to ensure compliance.

Duties and Responsibilities

• Assist Director in managing all divisions within managed care, including contract process and portfolio, development and maintenance of service operations, eligibility, network development and sustainability, and internal procedures necessary for success.
• Assist Director in managing the day-to-day operations of the contracting within managed care commercial division.
• Assist Director in managing quality initiatives, including managing network spending and increase performance on quality measures.
• Extrapolate raw hospital and professional services claims utilization data, analyze and model against historical and future contractual payment terms and prepare and present analysis to senior administrators with proposed future plan of action.
• Conduct annual financial review of contracted payers to ensure adherence to contractual payment terms, including but not limited to monitoring and modeling historical claims utilization data to include but not be limited to the following points of service and service categories: inpatient, outpatient, emergency services, durable medical equipment, primary care services, specialty professional services, high-cost drugs, high-cost implants, ancillary services.
• Perform financial impact analysis of changes in Payer reimbursement policies and fee schedules, as needed.
• Provide financial analysis of specific provider payment terms, as needed, to support medical cost review for the Finance leadership teams on a regular basis.
• Provide a consultative role to Departmental Leadership as they actively negotiate provider and hospital contracts.
• Provide reporting, operational metrics, tracking and forecasting.
• Identify trends in financial performance and providing recommendations for improvement.
• Perform drill-down analysis to identify medical cost drivers; advise leadership of contracting opportunities to mitigate future trends.
• Negotiates one-time Letters of Agreement and IPA Agreements.
• Manages renewal activity of assigned IPA Agreements, including the monitoring of expiration dates.
• Conducts contract negotiations for assigned health insurance plans, outside physician referral sources and external providers.
• Maintains provider and facility databases and contract information for new and renewal agreements, creates and evaluates financial analysis of contracts and contract profitability.
• Generate reports and provide financial analysis of revenue per department per physician (Physician Scorecard).
• Develops, implements and maintains policy and procedures to ensure compliance, prepares presentations and training, participates in the development of new system implementation, and identifies procedural and system inadequacies, and makes revisions, updates and adjustments where appropriate.
• Performs other related duties and participates in special projects as assigned. Perform other related duties and participate in special projects as assigned.

Minimum Qualifications

• Bachelor’s degree in Business, Health or Public Administration, Management or a degree related to the position.
• Possess 5 years’ progressive experience in managed care in an Academic Medical Center/hospital or clinic setting or with five (5) years of experience working at a Health Insurance Company.
• Demonstrated leadership ability including staff development.
• Expansive understanding of health care insurance companies and health care delivery systems.
• Direct experience with complex negotiations and contracting and managing capitation including PCP, partial risk and full risk, development of policies and procedures, claims processing & auditing, customer services, and provider relations.
• Extensive experience with hospital, physician, and capitation financial modeling and pro forma development within excel, access, word, and project management.

Preferred Qualifications

• Highly organized and able to quickly prioritize multiple assignments with high quality results.
• Exceptional communication (written and verbal) skills, including the ability to interact with a variety of external and internal audiences.
• Business understanding of Health Care Reform, Healthcare Exchange Marketplace, Medicaid expansion, Mandatory Medicaid and timelines.
• Ability to manage projects and project time constraints. Contract negotiation experience and skill.
• Problem solving skills.

Salary & Benefits:

UI Health offers competitive benefit packages, including vacation days, paid holidays, Floating Holidays, State University Retirement System, tuition waiver, tuition discount for dependents, and excellent medical, dental, and vision packages.

To Apply:

For fullest consideration, please submit a complete application and supplemental resume by December 31, 2024.