Vice President, Managed Care

Job Purpose

The Vice President, Managed Care Services will lead all aspects of managed care for Med-Metrix End to End Revenue Cycle customers. The Vice President, Managed Care Services will be responsible to negotiate managed care contracts and single case agreements and provide all areas of managed care support including reviewing pricing for accuracy, optimizing revenue and reviewing payer performance. The Vice President, Managed Care Services must have a deep understanding of healthcare reimbursement trends, exceptional ability to negotiate favorable contracts with payers, and possess excellent client relationship skills. The Vice President, Managed Care Services must also have a thorough understanding of the revenue cycle including third party payer requirements.

Duties & Responsibilities

• Responsible for the oversight, negotiation and strategic direction of managed care contracts for all Med-Metrix end-to-end revenue cycle customers.
• Develop processes to manage the implementation of completed contracts and ongoing management including tracking of critical contract renewal dates, ensuring proper loading of managed care contracts into Med-Metrix contract management system and overseeing the dissemination and communication of contract information to internal stakeholders.
• Monitor contract performance regarding financial performance, payment integrity and compliance with contract terms and key performance indicators.
• Oversee payer relationships for Med-Metrix
• Collaborate with Med-Metrix payment variance and accounts receivable services departments to analyze payer behavior and lead JOC meetings to address.
• Provide assistance/resolution to external and internal client inquiries
• Act as a technical expert in regard to financial class responsibility, to answer questions raised by clients and team members
• Maintain a current working knowledge of all healthcare related issues, state and federal regulations, and payer policies, especially those governing Managed Care contracts.
• Maintain confidentiality at all times
• Learn and comply with organizational and departmental policies and procedures
• Analyze and solve problems quickly and thoroughly
• Establish realistic goals and priorities concurrent with organizational objectives
• Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
• Understand and comply with Information Security and HIPAA policies and procedures at all times
• Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties
  
  

Qualifications

• 10 yrs. Minimum experience of managed care contracting within a health system or large medical group and reimbursement analysis in either a provider or payer setting
• Prior Management experience
• Extensive knowledge, experience and expertise in Managed Care contracting negotiations, language, modeling analytics, reimbursement methodologies for hospitals, shared savings and risk contracting, managed care regulations and quality/shared savings program metrics and methodologies
• Knowledge of governmental, legal and regulatory provisions related to collection activity
• Knowledge of insurance company practices regarding reimbursement
• Demonstrated skills in attention to detail, superior project management, analytical ability as well as the ability to coordinate and lead activities using a collaborative team approach
• Ability to handle multiple projects and perform independently under tight deadlines with a focus on effective implementation, clear communication and follow-up
• Ability to work well individually and in a team environment
• Able to work in a professional, corporate setting
• Must be reliable, responsible, goal oriented and flexible
• Strong interpersonal skills, ability to communicate well at all levels of the organization
• Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses
• High level of integrity and dependability with a strong sense of urgency and results oriented
• Excellent written and verbal communication skills required
• Gracious and welcoming personality for customer service interaction
  
  

Working Conditions

• Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.
• Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.
• Work Environment: The noise level in the work environment is usually minimal.
  
  

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.