MGR MANAGED CARE OPERATIONS

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Summary

MGR Managed Care Operations

Position Highlights:

• The Manager, Payer Strategies Operations is responsible for providing oversight, problem solving and operational training within the Payer Strategies Team in support of achievement of the organization’s payer, managed care, and business and financial plans.
• Responsibilities include, but are not limited to: creating training programs for managed care staff on all aspects of managed care operations, overseeing the validation of contractual rate updates within internal systems and the distribution of same; physician and hospital credentialing processes; Single Case Agreement process; project management needs associated with payer policies; the monitoring and escalation of payer issue tracking process; international agreements, and general Payer Strategies projects and efforts (e.g. support for new facility startups and new hospital offerings that require integration with payments).
• This position requires extensive knowledge of and experience in implementing and managing both commercial and governmental managed care network agreements, payment methodologies associated with hospital, physician, value-based care and transplant contracts.

Responsibilities:

• Leads and mentors the Managed Care team responsible for managed care operations
• Provides guidance, support, and training to ensure the team members’ growth and development
• Advises support staff when unusual work situations arise that require reallocation of workload
• Ensures staff meet deadlines and provide the highest level of support to Moffitt Teammates
• Supports recruiting and hiring of Contract Mangers and Contract Specialists
• Advises support staff when unusual work situations arise that require reallocation of workload
• Supports technology assessment and implementation as needed
• Manages other duties as assigned by Vice-President and Directors
• Serves as a subject matter expert on contracting and reimbursement related issues including identifying contracting opportunities for revenue improvement and administrative efficiency.
• Evaluates and understands contractual language as it relates to reimbursement methodologies I
• dentifies, escalates, and monitors operational issues impacting managed care contract  performance
• Actively oversees Soarian contract modeling and administration process
• Coordinates with other departments for required information or outputs (Care Coordinations, IT, etc.).
• Ensures payer policies are readily accessible to relevant stakeholders and central repository for policies is maintained and updated effectively
• Manages payer issues escalation to Fortune 100 companies and oversees office  collection/optimization of payer issue trends
• Oversees the Center's Single Case Agreement functions to ensure timeliness and accuracy of  process and provide input in single case agreement rates to ensure consistency between payers
• Oversees payer credentialing functions to ensure the timeliness and accuracy of Delegated Credentialing reports
• Supports technology assessment and implementation
• Oversees vendor management and communication including collaboration to maximize system performance
• Manages special projects as assigned by leadership
• Provides training and support to Contract Managers and Contract Specialists on issues affecting hospital reimbursements
• Provides guidance; works with leadership to develop training materials and narratives to ensure Team Members internal and external to Payer Strategies are able to identify and solve recurring problems
• Provides training updates to Revenue Cycle Management, Clinical and other staff on Payer Strategies internal processes
• Supports team on-boarding and training
• Mentors and coaches team to provide growth and development opportunities

Credentials and Experience:

• Bachelor’s degree – field of study: Business Administration, Project Management, Health Administration, or other Healthcare related field
• Minimum of five (5) years of managed care contract negotiations, implementation, and configuration, for both facility and physician contacts.
• Experience must include a minimum of three (3) years’ supervising/leading staff and managing projects with cross-functional teams (may be inclusive of the five (5) years).

(OR)

• Ten (10) years of experience running an operations function for a hospital working with senior leadership preferably in managed care or revenue cycle to ensure effective and efficient operation of the payer strategies and managed care departments in the execution of complex projects and initiatives.
• Experience must include a minimum of three (3) years’ supervising/leading staff and managing projects with cross-functional teams (may be inclusive of the ten (10) years).