Fallon Health Behavioral Health Contract & Vendor Relations Manager - Great Role in Growing Organization! in Worcester, Massachusetts
About Fallon Health
Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation’s top health plans, and is accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit fallonhealth.org.
The BH Contracting and Vendor Relations Manager serves as the key liaison to the BH vendor. This position is responsible for the analysis, negotiation/renegotiation, implementation, readjustment, evaluation, and continuous improvement of the vended BH contract and other BH-related provider contracts. Manages financial and operational issues related to contractual provider arrangements. Responds to both internal and external customers regarding provider contractual arrangements, both for contract implementation and ongoing operations.to handle multiple the BH vendor relationship as the main point of contact, managing the day to day operational work, associated projects and instituting and monitoring operational metrics. This position will collaborate with various internal departments and program/product stakeholders at all levels to support the governance of the vendor contract relationship, including, but not be limited to, evaluating and prioritizing multiple requests by internal departments/stakeholders, managing joint operating meetings, managing any potential changes in scope of vendor contract, and overseeing problem resolution and corrective action plans. Key interface between Fallon Health Regulatory Compliance and BH vendor to ensure the BH vendor is in compliance with federal and state requirements
Negotiates, develops and designs contractual provider arrangements including language and pricing methodologies.
Evaluates contractual payment methodologies in order to determine financial risk to insurer and provider (per diem, capitation, discount from charge, DRG, case rate, bundled payments, pay for performance programs, etc.).
Ensures the design, production, and distribution of site financial, utilization and member information; ensures the production and completeness of annual site settlement reports.
Interfaces between the Plan’s Finance department and individual sites for budget, financial reporting and settlement arrangements for all relevant products.
Serves as the liaison between Fallon Health and its BH Vendor, collaborating with the BH Vendor on implementation and testing of benefit changes, resolution of claims processing errors, and facilitation with addressing file feed issues and testing.
Performs quantitative analyses of various financial and clinical data in order to evaluate multiple contracting options.
Reports performance of ongoing contractual arrangements to appropriate parties.
Establishes and monitors performance guarantees (PGs) and holds vendor accountable to these PGs.
With input from Care Services and other Fallon Health departments, collaborates with the BH vendor to develop, refine, and regularly produce standard reporting packages.
Manages, coordinates and resolves operational issues related to specific areas of responsibility.
Serves as contact person for internal departments (i.e. Care Services, Claims, Finance, Care Management Services, Patient Relations, Marketing, Credentialing, Provider Relations, etc.).
Researches, analyzes and presents recommendations to Chief Medical Officer and Chief Financial Officer regarding contractual and financial decisions.
Collaborates with internal and external teams to promote behavioral health integration.
Maintains computerized tracking system for new and revised agreements. Coordinates and communicates contractual information to appropriate departments within FCHP.
Maintains assigned provider network; physician, hospital, ancillary, and/or carve out vendor as assigned by Chief Medical Officer or designee.
Prepares, updates and maintains files and database for all assigned provider contracts.
Serves as committee member in cross-functional teams as assigned by Chief Medical Officer or designee.
Analyzes and presents financial reports to providers. Makes recommendations to providers regarding quality and cost improvements.
Performance Management: Develops and institutionalizes operational metrics
Performance Management: Is responsible for research, collection, tracking and reporting of vendor metrics
Performance Management: Develops and maintains vendor scorecard to be reviewed with vendor and internal departments and stakeholders
Performance Management: Conducts vendor meetings to review vendor performance linked to regulatory compliance and contractual obligations
Main point of contact for vendor and internal departments: Tracks escalated issues and reporting of root cause analysis
Main point of contact for vendor and internal departments: Troubleshoots all vendor problems and presents to management as required
Main point of contact for vendor and internal departments: Identifies and implements continuous enhancements and efficiencies associated with vendor management
Main point of contact for vendor and internal departments: Performs regulatory compliance and performance of Fallon’s BH vendor
Main point of contact for vendor and internal departments: Maintain vendor information and share with internal teams related to contract obligations and day to day updates
Bachelor’s degree required.
Previous background in behavioral health (BH) and/or licensure as a BH professional (e.g., LMHC, LCSW, LICSW, etc.) is preferred but not required.
Posted Date 1 month ago (2/25/2021 1:14 PM)
Job ID 6242
# Positions 1
Category Behavioral Health