The Senior Contract Manager is responsible for facilitating and managing the life cycle of managed care contracts for proprietary genomic lab tests that have been adopted into policy by managed care payors. Direct responsibility includes the following activities: contract language review; identification and oversight of payor requirements; organizational deployment of payor contracts; serve as primary liaison across all relevant departments who depend upon the accuracy and timeliness of contract provisions.
- Collaborate with the Field Managed Care team to develop account specific objectives to support the overall, strategic managed care business plan, including the potential financial impact of various scenarios.
- Oversight of documents through the contracting process including review of documents, obtaining all information necessary to successfully implement the contract, approvals (including development of business cases for proposed terms) and routing, communicating information to the appropriate parties, and updating contracting databases.
- Maintain payor information and contract terms in all systems (includes coverage policy changes, criteria validation processes, member lives, revenue status information).
- Facilitate conversations with appropriate departments (e.g. billing and reimbursement teams, finance, customer service) early in the contracting process to provide updates, discuss potential operational issues, and develop and follow up on plans to address such issues.
- Assist in managing payor specific and national price changes (includes monitoring the timing, calculations, communications with payers and internal departments).
- Assist in the development and ongoing maintenance of boilerplates, including facilitating review with appropriate internal parties and legal.
- Ensure contractual obligations of all parties are met on a timing basis including data exchange, development of quarterly business reviews, performance milestones or guarantees, credentialing.
- Lead, manage and develop the Commercial Contracts team
Ensure the team has the support and tools needed to manage the key milestones for contract projects
- BA/BS required.
- 12+ years contracting experience within the healthcare industry. Payor experience highly desired.
- Knowledge of and/or experience with private managed care payors and reimbursement process.
- Understanding of market-related issues, contract development, negotiation, and pull through as well as the legal and regulatory implications associated with Private and Government payer contracting.
- Strong project management skills required.
- Effective communication skills, both written and oral.
- Collaborative and works effectively as a team member.
- Strong attention to detail and organizational skills.
- Ability to present recommendations supported by analytical evaluations.
Technical proficiency in SalesForce.com, MS Access, Excel, and Word programs.
TRAVEL, PHYSICAL DEMANDS AND WORK ENVIRONMENT:
- Travel Requirements:
- Ability to work at our Redwood City office
- Standing or sitting for long periods of time may be necessary