Senior Manager - Somerset, NJ

Job Overview:

The Senior Manager is a highly analytical health care finance professional with experience in managed care contract negotiations, innovative and value based contracting experience, and account management and claims processing within the health insurance industry as well as industry reimbursement benchmarks. The Senior Manager will be responsible for hospital, physician, ancillary contracting data integrity, material contract non-compliance resolution, contract rate strategy development, contract negotiation for both fee for service payment arrangements with commercial and governmental managed care plans. In working with RWJBH revenue cycle leadership partner relationships, where appropriate, installs internal and external procedures to ensure revenue stream safety net is in place.

Qualifications:

Required:

• Bachelor's Degree or equivalent experience in Healthcare

• Must have a minimum of three years of managed care contracting related experience in responsible positions in health care contracting, with health system experience required.

• Must have a minimum of two years experience managing employees
• Must have advanced knowledge of healthcare, managed care systems, HMO marketplace and market trends, value based payment contracting.
• Contracting experience mandatory; financial analysis experience required
• Well-developed negotiating skills required
• Advanced knowledge of contract related activities including: negotiations, legal, regulatory, operational, finance and relationship management
• Strong problem-solving skills
• Strong written communications skills
• Advanced Excel spreadsheet skills are required
• Ability to multi-task and manage multiple projects simultaneously is required
• Advanced communication and analytical skills required to develop positive working relationships both internally and externally
• Exceptionally be able to communicate effectively in person, over the phone and maintain professional written communication

Preferred:

• Financial analysis skills and contracting regulatory skills strongly preferred

Essential Functions:

• Negotiates contracts and subsequent rate amendments for RWJBH system entities

• Reviews and recommends managed care contract language and negotiates such language recommendations with health plans, and in accordance with legal provisions from office of General Counsel.

• Coordinates financial analyses for non-hospital entities working with CSH, joint venture partners (professional and ancillary) and the Medical Group.

• Is highly knowledgeable in contract structures, revenue cycle, and reimbursements/regulations for health system services including ayer policy requirements.

• Prepares and leads comprehensive financial impact analyses on actual and proposed contracts, with predominant focus on value based models.

• Maintains strong relationships with key managed care payers and resolves material contract compliance issues

• In working with RWJBH revenue cycle leadership and Joint venture partner relationships, where appropriate, installs internal and external procedures to ensure revenue stream safety net is in place.

• Reviews results of such efforts and implements sustainable process improvement to prevent revenue leakage and enhance revenue optimization.

• Works closely with other Managed Care team members and other company site/service line specific to execute strategic initiatives:

  • Defensible pricing strategies.

  • Innovative contracting solutions.

  • Funding rate levels and contract operations improvements.

  • Maintains strong working knowledge of leading insurance market and payer product platforms.

  • Comprehensive understanding of varied reimbursement methodologies with predominant strength of fee-for-service structures and rates for health system entities.

• Demonstrates a deep understanding managed care contracting, billing, claims processing and collections Demonstrates strong skill in statistical analysis.

• Oversees contract management systems builds and maintenance for all RWJBH professional and ancillary entities.
  • Includes daily report review and discussion with revenue cycle leadership teams to ensure the contract management system is correctly built.
• Reviews and ensure necessary Managed Care Team members are included in analytical analysis to determine if Materiality Breach has occurred and work with Payer to remedy.
• Prepares revenue forecasts for budgetary purposes for managed care payers, with a specialized focus on physician and other non-hospital entities.
• Coordinates the daily activities of the Payer Services staff as it relates to the processes for Children s Specialized Hospital Credentialing, Contract Management, and Charge and CSH Charge Master.
• Demonstrates exceptional communication skills with various internal and external partners/stakeholders, including insurance company negotiators, System management personnel, Physicians, and staff and management personnel in operational areas throughout the System (Credentialing, Legal, Revenue cycle, and Business Development).
• Works with site/entity directors to define, initiate, and direct operational reporting for the acute hospital sites including establishing goals and metrics.

Other Duties:

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

At RWJBarnabas Health, our market-competitive Total Rewards package provides comprehensive benefits and resources to support our employees physical, emotional, social, and financial health.

• Paid Time Off (PTO)
• Medical and Prescription Drug Insurance
• Dental and Vision Insurance
• Retirement Plans
• Short & Long Term Disability
• Life & Accidental Death Insurance
• Tuition Reimbursement
• Health Care/Dependent Care Flexible Spending Accounts
• Wellness Programs
• Voluntary Benefits (e.g., Pet Insurance)
• Discounts Through our Partners such as NJ Devils, NJ PAC, Verizon, and more!

Choosing RWJBarnabas Health!

RWJBarnabas Health is the premier health care destination providing patient-centered,

high-quality academic medicine in a compassionate and equitable manner, while delivering

a best-in-class work experience to every member of the team. We honor and appreciate the privilege of creating and sustaining healthier communities, one person and one community at a time. As the leading academic health system in New Jersey, we advance innovative strategies in high-quality patient care, education, and research to address both the clinical and social determinants of health.

RWJBarnabas Health aims to truly make a unique impact in local communities throughout New Jersey. From vastly improving the health of local residents to creating educational and career opportunities, this combination greatly benefits the state. We understand the growing and evolving needs of residents in New Jersey whether that be enhancing the coordination for treating complex health conditions or improving community health through local programs and education.

Equal Opportunity Employer