Manager, Managed Care Contracting

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General Description: TheManager, Managed Care Contractingis responsible for negotiation and implementation of Commercial, Government payer and Value-based contracting. Critical responsibilities of this position encompass contract administration including maintenance, contract renewals processing and renegotiations. Under the direction of the SVP, Managed Care and the Director, Managed Care Contracting, the Manager, Managed Care Contracting initiates contract-related financial modeling and analysis and implements contracting initiatives to achieve organization and department goals, and monitors payer activity to ensure their compliance with contractual and regulatory terms and provisions. The Manager, Managed Care Contracting is expected to demonstrate, through plans and actions, a consistent standard of excellence to which all departmental work is expected to conform. The standard should be based on establishment and maintenance of a constancy of purpose, focus on continuous improvement with the Manager's area of influence and on delivery of the highest degree of quality service possible. Position could be considered for remote work with 2-3 days in office.

Essential Responsibilities:

Responsibilities listed in this section are core to the position. Inability to perform these responsibilities with or without an accommodation may result in disqualification from the position.

• At the direction of the SVP, Managed Care and the Director, Managed Care Contracting, negotiates managed care agreements, Letters of Agreement (LOAs), single case agreements (SCAs) and necessary amendments for all managed care payers to meet financial goals and maximize the potential for revenue collection and support operational efficiency. Negotiates contract language and coordinates document review, negotiates delegated credentialing agreements, and obtains contract signatures and timely return of executed contract documents.

• Negotiates and monitors Value-based contracts.

• Supports the review of contract performance and final reconciliation.

• Prepares financial feasibility models for contract renewals to ensure that executed contracts align with department objectives.

• Evaluates financial impact of regulatory changes.

• Supports Operational Teams in the development of business plans and budgets for new services.

• Ensures superior customer satisfaction through purposeful internal and external communication and fosters long term effective business relationships with payer representatives by being accountable, collaborative, and genuine.

• Keeps informed of new managed care reimbursement strategies or methodologies such as bundled payment, pay for performance opportunities or other means of compensation incentives.

• Prepare claims settlement agreements when applicable.

• Performs other duties as assigned.

Minimum Qualifications:

Education: Bachelor's degree required.

Experience: 3-5 years of progressive leadership experience required. Experience within an Academic Medical Center, Multi-hospital Health System or Managed Care Organization (MCO) with demonstrated experience in healthcare analytics and medical economic modeling preferred.

License(s)/Certification(s)/Registration(s) Required: None.

Knowledge, Skills, and Abilities:

• Strong knowledge of hospital and physician reimbursement methodologies (i.e., DRG, per diem, fee schedule, APC).

• Working knowledge of billing/coding terminology (i.e., ICD-10, CPT, Revenue codes); Procedural knowledge of hospital and physician practice accounts receivable management.

• In-depth knowledge of payor contracting and negotiation.

• Working knowledge of privileging, credentialing, provider enrollment and managed care contracting requirements, practices, and industry standards.

• Ability to be a liaison between Managed Care, Revenue Cycle and Operations.

• Ability to work collaboratively with Revenue Cycle Management (RCM) to address underpayments and incorporate lessons learned from vendors and colleagues into contract negotiation strategies.

• Ability to utilize assessment and communication tools to monitor the performance of agreements and other information critical to the organization.

• Ability to make a significant contribution to the organization's overall effectiveness.

• Must be a team player who strives for excellence and is dedicated to outstanding customer service.

• A mature approach to problem-solving for all types of issues.

• Extensive experience with Microsoft Office - Excel, Access, Word and Power Point.

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