Job Description

Location: Steward Health Care
Posted Date: 1/4/2023

POSITION SUMMARY:

The Managed Care Contracts Manager will implement strategies to improve managed care net revenue for the market. The Managers duties will include (but not be limited to); direct administrative, legal, operational and financial issues related to contract/payor negotiations. Manages policies and procedures for the financial and data operations of managed care contracts. Manages contracts, negotiates and sets rates, and reviews reimbursement levels and managed care agreements to ensure that proper payment practices are utilized. Implements processes that encourage and inform the organization how to increase levels of reimbursements.

KEY RESPONSIBILITIES:

  • Renegotiation of physician managed care agreements in accordance with the Contracting Plan developed each fiscal year.
  • Serves as the “point person” to the Steward hospitals’ business offices with regard to tracking and reducing managed care denials and underpayments, including restitution or other prompt pay penalties.
  • Assists in the interpretation of managed care agreements as it pertains to contract language and reimbursement terms.
  • Assists in the negotiation and renegotiation of managed care and/or other third party payor contracts to achieve operation objectives with results that are in accord with overall market needs and budgeted targets.
  • Carries out appropriate managed care related education and training, including the roll-out and implementation of new payor contracts; and assures that new contracts are implemented in a timely and accurate manner.
  • As necessary, completes hospital credentialing and re-credentialing applications for managed care organizations with which market hospitals are contracted.
  • Responsible for the distribution of managed care related information to the appropriate departmental directors and managers within the hospitals.
  • Works with various hospital departments to complete managed care and service line analysis to ascertain if specific services are profitable under certain conditions.
  • Participates in weekly, regional revenue cycle teleconference to address existing reimbursement related issues, including but not limited to claim denials, underpayments, and bad debt.
  • Provides managed care resources to physicians, as requested.
  • Coordinates special projects regarding reimbursement and operational issues with managed care payors via monthly or quarterly meetings with the payors.
  • All other duties as assigned.

REQUIRED KNOWLEDGE & SKILLS:

  • Excellent interpersonal skills with the ability to establish effective communications with internal and external clients. This shall include oral and written communication skills.
  • Effective leadership and management skills; and project management experience so to ensure projects are completed, timely.
  • Ability to prioritize work with minimal supervision, in order to independently carry out the duties of the position.

EDUCATION/EXPERIENCE/LICENSURE/TECHNICAL/OTHER:

  • Education: Bachelor’s Degree preferred
  • Experience (Type & Length): Minimum requirement of five (5) years’ experience in health care or insurance organizations with experience in contract negotiation/renegotiation, physician interaction, network development, and alternative reimbursement methodologies (i.e., risk arrangements).

Application Instructions

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