Managed Care Contract Associate II
This position is responsible for preparation of proposals, negotiation of contracts, and administration of commercial and governmental contracts in accordance with company policies and legal requirements. Requires familiarity with a variety of healthcare reimbursement industry concepts, practices, and procedures. Assists in the implementation of and financial analysis of managed care contracts and participates in revenue improvement initiatives on behalf of the company.
Relies on extensive experience and judgment to plan and accomplish goals.
- Receive, organize and prioritize contracting requests from internal and external sources for determination of participation.
- Handle day-to-day communications with payers and renewal negotiations on existing contracts.
- Evaluate new payer arrangements as they are presented.
- Make recommendations concerning changes in payer agreements.
- Review language and summarize Managed Care contracts that are being considered for contracting and gather all data pertinent to finalize contract executions.
- Pursue optimal reimbursement in discovering opportunities that would increase revenue through payer analyses.
- Identify non-standard arrangements as an alternate to contracting and coordinate with Reimbursement Team on implementation of non-standard arrangements and outreach programs.
- Coordinate with Variance Auditor in resolving late or inaccurate payments problems, and in auditing payers remittances and compliance with contract terms.
- Coordinate with Analytics to determine the financial impact of new and renegotiated managed care contracts; suggest counter offers.
- Provide customer service to client facilities in order to increase client satisfaction.
- Answer client facility questions, problems, and resolve issues in a variety of ways using best judgment to ensure client satisfaction.
- Resolve escalated client facility complaints.
- Communicate and provide expert guidance for Operational Teams as necessary regarding plans under negotiation, pertinent events, negotiating successes and difficulties, and recommended actions.
- Coordinate with Med Staff Administration Team with regard to provider enrollment with Managed Care plans.
- Create and maintain Managed Care files containing executed contracts, amendments, fee schedules, financial analyses, and all other pertinent documents.
- Create and maintain SalesForce Managed Care database with current information for all contracts and arrangements.
- Other responsibilities, as assigned.
Knowledge, Skills, and Abilities:
- Ability to work and make decisions independently, displaying a keen eye for attention to detail, and providing accurate status of progress, issues, and risks on all projects.
- Ability to exercise considerable individual judgment and initiative, and to rely on experience and judgment to plan and accomplish goals.
- Ability to work under moderate stress and pressure while maintaining a positive, professional manner both in person and via phone, e-mail, business letter, or fax.
- Ability to produce quality and timely results while handling multiple projects, exhibiting good organizational and time management skills.
- A wide degree of creativity and latitude is expected.
- Must work well with others, exhibiting professional courtesy and excellent customer relation skills.
- Ability to communicate clearly and effectively, both verbally and in writing.
- Ability to effectively problem solve, and to collect and analyze complex data.
- Ability to negotiate, read, and navigate Managed Care contracts.
- Ability to coordinate projects with diverse groups and individuals.
- Ability to prepare and conduct effective presentations.
- Strong leadership skills required.
- Willingness to adhere to productivity goals and departmental guidelines.
- Advanced understanding of reimbursement and how it relates to emergency and hospitalist medicine, and of state and federal insurance laws.
- Proficiency in Microsoft Office products.
EDUCATION (Required and/or Preferred):
- Bachelor's Degree from an accredited academic institution required.
- Minimum of one year experience in contract negotiations.
- Understanding of healthcare reimbursement concepts.
- Ability to collaborate with internal and external stakeholders to meet goals.
- Understanding of contract language.
- Effective communication skills.