Managed the facilitation and implementation of each Managed Care agreement through internal and external operational reviews. Proactively identifies operational and financial improvement opportunities relating to contract performance as well as responds to payor negotiation inquiries. Manages the hospital / payor negotiations and interaction to facilitate the contractual relationship between both parties.

PRIMARY DUTIES AND RESPONSIBILITIES

1. Facilitates and assists in the building and maintenance of all contract models within CPA, the contract modeling system.
2. Reviews payor performance data such as denial rates, bills on hold, days in A/R, etc. to better leverage the hospital’s position in negotiation and joint operation committees.
3. Manages the operations and strategy of each contract negotiation.
4. Reviews contract language for fiscal and operational clauses that may put the hospital at an interpretive risk.
5. Coordinate Physician and Patient information requests regarding network acceptance and patient complaints.
6. Serve as the key contact point in the Revenue Cycle Steering Committee, which meets quarterly to review updated initiatives ongoing by each member as well as review performance benchmarks being met by the hospital.
7. Acts as a primary contact for other hospital departments directly affected by the hospital/payor relationships such as Business Office, Patient Access, Medical Records, Decision Support, and QI. Coordinates the Managed Care information dissemination with these departments.
8. Prepares and often works with Decision Support to prepare the supplemental analysis necessary to capitalize on emerging services, new technology, cost trends, etc.
9. Prepares and maintains “Physician Status Tool” to monitor and track what physician contracting issues are outstanding and need to be addressed.
10. Serves as a resource to physician offices to assist with Insurance Company matters such as credentialing, contracting, reimbursement trends, industry knowledge etc.
11. Investigates physicians with high utilization to determine which payors and products are not part of their participation agreements. Provides solutions and physician assistance to broaden the payor participation portfolio of those physicians.

Qualifications:

REQUIRED:

1. Bachelors Degree or five-year equivalent provider negotiation and managed care experience.
2. Strong understanding of hospital reimbursement methodologies.
3. Experience with contract modeling software.
4. Three (3) years of Managed Care or Hospital Financial experience.
5. Ability to work independently.
6. Strong management and leadership skills.
7. Strong analytical skills.
8. Excellent organizational skills
9. Excellent communication skills.
10. Strong working knowledge of computer spreadsheet programs.
11. Excellent project management skills.

PREFERRED:

1. McKesson/HBOC Trendstar CPA and CCA modules
2. MBA or Other Masters Equivalent