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Department:
Managed Care ContractingUnder the direction of the Vice President of Managed Care Contracting, the Manager of Payer Contracting promotes and manages all managed care contracting efforts on behalf of the hospital and clinics. The Manager of Payer Contracting will be responsible for assisting with all payer contracting. The responsibilities include negotiating, implementing, and maintaining all payer contracts and the respective policies for each. The Manager of Payer Contracting keeps abreast of all managed care marketplace activities and logically and cohesively adjusts strategies accordingly. This position will be required to have extensive managed care contracting experience in a major health plan or healthcare system, as well as in a mid to large size hospital setting.
Accountable for the negotiation, implementation, and contract performance tracking of all managed care
contracts for the health system.
Review and analyze contract language, including reimbursement methodologies and fee schedules.
Maintain the centralized contract repository and ensure version control.
Ensure contracts comply with federal and state regulations and partner with internal and external Legal
teams to review terms to mitigate risk.
Serve as the primary liaison between the organization and payer representatives.
Support operational teams with contract interpretation and issue resolution.
Support identification and resolutions of denials and underpayments
Identify opportunity and negotiate supplemental payments
Track key contract metrics including payer mix, expiration/renewal dates, and reimbursement rates.
Leads and maintains collaborative payer and employer relationships and serves as the liaison to business,
government, and the public in relation to managed care contract matters.
Maintains current knowledge of managed care principles and oversees the achievement of targeted contractual levels.
Identifies opportunities for improvement in managed care contracting and contractual performance with input from Case Management, Patient Financial Services, Registration and/or other departments.
Oversees the day-to-day collection of clinical, financial, and contracting data needed, for the analytical support of the payer contracting process and hospital business development efforts.
Serves as support role to the Vice President of Managed Care, accomplishing key tasks as assigned.
Performs other duties as assigned.
Education: Bachelor’s degree required. Master’s degree preferred.
Experience: Three (3) years’ experience in managed care contracting, experience working with Epic, and experience working with contract management software.
Knowledge: Knowledge of California and Federal rules related to managed care contracting, billing and compliance, and of population health and total cost of care.
Licensure: None.
Essential Technical/Motor Skills: Proficient in Microsoft Office applications, including Excel, PowerPoint and Word. Ability to operate office equipment, including printers, copiers, computers, adding machine and fax machines.
Interpersonal Skills: Excellent skills in dealing with members of the public, patients and co-workers by utilizing positive communication, both written and verbal. Works effectively with administration, employees and medical staff.
Job Specifications:
● Union: Non-Affiliated● Work Shift: Day Shift● FTE: 1.0● Scheduled Hours: 40If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!
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