What are the responsibilities and job description for the Managed Care Contracting Specialist position at CommuniCare Corporate?
Managed Care Contracting Specialist
The CommuniCare Family of Companies is a fast-growing provider of long-term care with over 130 skilled nursing facilities, 5 behavioral health hospitals, 3 substance abuse treatment centers, outpatient behavioral health services and a transportation company, which are located throughout 7 states. CommuniCare is dedicated to our goal of creating Caring Communities where staff, residents, patients and families join hands to overcome their daily challenges.
CommuniCare is currently recruiting to fill a key position, Managed Care Contract Specialist, to oversee strategy and development for all Managed Care Services, Case Management, and Contracting specific to negotiating Single Case Agreements (SCA). The Specialist is responsible for full-managed care SCA contract life-cycle support, including collaborating with team members, negotiations, verifying correct reimbursement rate in PCC, and assisting with payment issues when applicable. This positon reports to the Corporate Director of Contracting & Managed Care.
Job Responsibilities include:
- Identify opportunities to increase SCA rates and lead those discussions.
- Develop and foster strong payor relationships built on trust and collaboration.
- Develop and foster strong relationships with the field.
- Manage payor expectations throughout the development and negotiation process.
- Have an understanding of regional, state, and federal regulations, laws, and legislative agendas regarding the healthcare industry that impact CommuniCare in order to improve partnership models.
- Report monthly SCA metrics.
- Maintain patient confidentiality and functions within the guidelines of HIPAA.
- Develop key resources for the field on SCA negotiations, costing out, etc. to aid in the improvement of revenue.
- Support and educate Pre-Cert, Case Management, and Revenue Cycle on SCA Process.
- Solve complex issues in a timely and appropriate manner with minimal management oversight and attention to resources.
- Maintain Managed Care rate sheets.
- Assure contracts are filed and labeled timely and according to CHS naming convention.
Training:
- Responsible for ensuring an effective on-boarding and providing comprehensive training quarterly to team members on single case agreement process.
Desired Skills and Experience:
- Long Term Care /SNF Experience preferred
- Knowledge and relevant work experience in the Managed Care/insurance sectors in long term care, including case management and contract language etc.
- Must have presentation experience and excellent written and verbal communication skills.
- Knowledge of medical contracting methodologies, claims pricing, and reimbursement
- Independent thinker and decision maker
- Strong analytical and problem-solving skills, with attention to detail
- Proficient computer skills and knowledge of Microsoft Office, specifically Excel
- Ability to prioritize and manage multiple projects
- Solid ability to learn new technologies and the technical aptitude required to understand flow of data through systems, as well as system interaction
Benefits
As a CommuniCare employee, you will enjoy competitive wages and PTO plans. We offer full time employees a menu of benefit options from life and disability plans to medical, dental, and vision coverage from quality benefit carriers. We also offer 401(k) with employer match and Flexible Spending Accounts.
About Us
A family-owned company, we have grown to become one of the nation’s largest providers of post-acute care, which includes skilled nursing rehabilitation centers, long-term care centers, assisted living communities, independent rehabilitation centers, long-term acute care hospitals (LTACH), substance abuse treatment centers and outpatient behavioral health services. Since 1984, we have provided superior, comprehensive management services for the development and management of adult living communities. We have a single job description at CommuniCare, "to reach out with our hearts and touch the hearts of others." Through this effort, we create "Caring Communities" where staff, residents, clients, and family members care for and about one another.
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