Senior Contract Manager

ElderServe Health is a mission-driven, nonprofit managed care organization serving the New York metropolitan area. ElderServe provides long-term services and supports to more than 20,000 older adults and adults with disabilities across New York City, as well as Westchester, Nassau, and Suffolk Counties. ElderServe primarily serves a frail and elderly membership who is predominantly dual-eligible and enrolled in Medicaid managed long-term care, Medicare-only and integrated Medicaid-Medicare plans. The CareSource and ElderServe affiliation addresses these critical long-term care needs to help members be as healthy and independent as possible.

Job Summary:

The Senior Contract Manager is tasked with the responsibility of efficiently ensuring provider contract terms and rates are propagated through multiple systems. This includes ensuring synchronization and validation of these terms into the Contracts, Authorizations, and Claims databases. This role facilitates a seamless implementation process for providers and conducting thorough audits of rates within the databases to guarantee accuracy. Additional responsibilities of this role include coordinating with third-party software vendors to articulate requirements, develop, and test solutions for the effective implementation of business processes.

Essential Functions:

• Serve as the primary finance liaison with the internal compliance department ensuring contract information meets the specific data and workflow requirements for the claims adjudication system.
• Collaborate with external provider networks to obtain essential data elements and formats, and ensure the receipt of all necessary information for accurate and timely claims processing.
• Verify payment information is correctly captured and integrated, which is vital for the efficient and effective adjudication of claims.
• Maintain clear communication and coordination with external partners to ensure all relevant data is available to reduce errors and delays in the payment process.
• Work with IT department to obtain, develop and integrate automated files from contracts for blanket provider agreements, such as minimum wage adjustments. Ensure all amendments are accurately reflected in the system to maintain compliance and consistency in provider payments.
• Obtain contracts and contract amendments from Compliance as they are executed. Ensure all information is entered timely to ensure no delays in payment.
• Perform and oversee regular audits of the claims system to ensure rates are entered accurately to maintain the integrity and accuracy of the claims adjudication system, ensuring all rates comply with regulatory standards. Ensure any provider contract rate and term discrepancies are promptly identified and corrected.
• Review monthly CMS precluded provider list and notify other areas of business to terminate contract, change authorization, and notify clinical staff.
• Closely collaborate with Claims and Authorizations senior leadership, taking ownership of key operational processes and ensuring strategies and decisions are aligned with organization goals and regulatory requirements.
• Coordinate with third-party software vendors to articulate business requirements, develop and test solutions for the effective implementation of business processes. Ensure that software solutions meet the organization's needs and support critical business functions. Actively participate in the development and testing phases to ensure final solutions are robust, efficient and aligned with business objectives, thereby enhancing overall operational effectiveness.
• Perform any other job related duties as requested.

Education and Experience:

• Bachelor's degree required
• Equivalent years of relevant work experience may be accepted in lieu of required education
• Three (3) years of healthcare operations or contracting experience required

Competencies, Knowledge and Skills:

• Expert proficiency in databases and Excel
• Ability to meet multiple deadlines timely and accurately
• Ability to anticipate, recognize and resolve issues
• Ability to clearly and concisely articulate issues
• High level of attention to detail and accuracy
• Strong critical thinking and reasoning skills
• Ability to work well with multliple disciplines
• Excellent communication and interpersonal skills, with the ability to collaborate effectively with internal and external stakeholders
• Strong analytical thinking and problem solving skills

Licensure and Certification:

• None

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time
• Travel is not typically required

Compensation Range:
$72,200.00 - $115,500.00 CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type:
Salary

Competencies:
- Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.