Senior Contracting Manager

Location:

Pay Range:

Under the oversight of the Director of Contracting & Credentialing, responsible for a wide variety of duties related to the development, implementation, and ongoing management of the company's managed care contracting function. Primary responsibilities include contract administration, review and analysis of contract proposals, development of managed care strategies, and a liaison role to both external and internal customers and other special projects.

KPA1-Contract Negotiation & Renegotiation

Job duties included but not limited to:

• Assist in the strategic development and implementation of Managed Care and Payer Contracts on a national, regional, and local level

• Negotiate and renegotiate managed care and payer contracts consistent with contracting goals

• Development of business decision support materials and proposals

• Review and analysis of contract language and reimbursement terms in existing and potential managed care agreements

• Cultivate relationships and maintain communications with health plans and payors

• Assist with the investigation and evaluation of payer markets in different states (payer mix, reimbursement issues, and state regulatory statutes)

• Oversee transitions-prepare payer target list, manage weekly oversight, prepare payer status updates for all internal departments.

• Work with complex payer affiliations such as PHO's, CIN's and IPA's.

KPA 2-Contract Maintenance

Job duties included but not limited to:

• Prepare various reports to track and monitor financial performance of contracts

• Prepare reports to review, assess and analyze utilization trends and overall performance of group contracts

• Assist to maintain and organize the managed care contracting database and/or document folders

• Conduct annual review of each contract to identify opportunities for improved or additionalservice(e.g. Radiology, Pathology, Urology, etc.)reimbursement

• Development and ownership of financial models to support contracting decisions, including modeling and analysis of innovative contracts

KPA 3-Contract Implementation

Job dutiesincluded but not limited to:

• Perform contract audits prior to signature process

• Disseminate contract rates and information to designated individuals for adherence to contract terms and definitions

• Gather and disseminate information for the Payer Matrix which outlines key contract terms, data elements, and other pertinent information needed to properly set up insurance plans and patient accounts

• Coordinates staff communication of contractual requirements, updates on policy and operational changes and other contract-related information to various departments within the organization

KPA 4-Payer Issues

Job duties included but not limited to:

• Address underpayment issues with payer representatives until resolvedor escalated to Senior Manager

• Work with Directorand/or Assistant Directorof Revenue Cycle,and Director of Contracting and Credentialing on payer issues

• Trackpayer issuesand impacts to use for support in future negotiations.

1. Education:

• Bachelor's degree from four-yearcollegeor university; orequivalentrelatedexperience preferred.

2. Previous Experience:

• 5 yearscumulativeexperience in healthcare managed care contracting working on either the provider or payer sides of health carepreferred.In-depth knowledge of the healthcare industry including billing and claims, medical coding, payer/provider relations, contracting processes, fee schedules and reimbursement methodologiesrequired.

3. Core Capabilities:

• Work requires a professional level of knowledge in health insurance or health care administration.

• Work requires essential knowledge of managed care concepts, an understanding of the breadth of clinical services provided and the ability to effectively communicate (oral and written) at a highly professional level.

• Work requires strong analytical ability to solve complex problems

• Must possess advanced interpersonal skills to effectively interface with all levels of management and staff as well as external business-related associates

• Work requires teamwork and the ability to work well with all levels of the business

• Must demonstrate the ability to provide leadership and effectively communicate (both oral and written) to all levels of management and staff.

• Must be proficient in creating and utilizing MS Excel spreadsheets and all other MS Office programs

4. Certifications/Licenses:Valid driver's license in the state of residence is required.

5. Travel:Required for meetings and as needed to meet with payers.

6. Standard Work Days/Hours:M-F; Day

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