What are the responsibilities and job description for the Manager Payor Provider Contracting Managed Care position at USA CLINIC SL?
The Manager Payor Provider Contracting Managed Care will provide strategic direction for and oversight of all managed care network development activities, oversee negotiation of all managed care contracting activities for fee-for-service (FFS) agreements, and leading and directing strategic activities associated with negotiating, implementing, and maintaining complex managed care contracts and relationships with third party risk bearing entities (i.e. payers and providers). Achieving this by working collaboratively with Revenue Management and Information Services departments to address operations, utilization and reimbursement issues Manages the tracking, approval, administration, and post-implementation process of all managed care contracts throughout the contract life cycle.
Only candidates who can reliably commute to the position's location in Northbrook, Illinois will be considered.
Responsibilities
Oversees the negotiation of all managed care contracting activities including but not limited to:
All for fee-for-service (FFS) agreements
All "ad-hoc" individual case agreements in accordance with policies and standards.
Negotiating complex managed care contracts and securing optimal reimbursement rates that maximize utilization and increase value.
Lead and Direct all strategic activities associated with negotiating, implementing, and maintaining complex managed care contracts and relationships with third party entities.
Work within an evolving business line to coordinate contract negotiation, implementation, and administration for Client's new healthcare services and solutions.
Monitor and analyze performance of third-party payer agreements including profitability, volume, strategic initiatives and payer/provider compliance issues Establish and maintain a system of reviewing and assessing changes in the Federal and or State regulations in regard to Managed Care contracts
Achieve and maintain a full understanding of Medicare and or Medicaid pricing reimbursement and structure for both Payors & providers.
Partner with the management team to identify, develop, and implement appropriate approaches, processes, and tools that elevate the analytics group.
Lead the implementation of managed care contracts with internal departments to develop and maintain systems to disseminate contract information.
Lead and manage the contract terms and commitments to assure all deliverables are adhered to and take proactive measures before key milestones are missed.
Work with corporate and field on any reimbursement issues and brings exceptions or non-standard requests to the attention of senior management where appropriate.
Maintain communication regarding third party participation, contract compliance, and any other operational issues or opportunities.
Review Third Party medical adherence Contracts to ensure operational requirements can be met and implemented.
Negotiate, analyze and model current, proposed, and final pricing terms for payors in accordance with pricing standards.
Lead the development and implementation of an annual strategic plan for third party payer contracting, including the continued development of opportunities and implementation of pricing strategies and contract language standards.
Monitor the technical links between the Third-Party Provider and data tracking systems to assure reported issues are properly captured, reported, prioritized and managed to closure.
Work with appropriate internal and external parties to load and update new/existing location, market, and provider information.
Manage and audit the loading and updates of pricing and reimbursement terms to ensure contract compliance and appropriate profit and reimbursement.
Perform additional duties as assigned.
Requirements
Bachelor's degree, required
5 years in a similar role, required.
5 years monitoring and analyzing performance of third-party payer agreements including profitability, volume, strategic initiates, and payer/provider compliance issues, required
Ability to work within an evolving business line to coordinate contract negotiation, implementation, and administration for Client's new healthcare services and solutions.
Expertise in managed care contracts of healthcare services, and their respective business issues and potential opportunities.
Benefits
Health
Dental
Vision
401K & Company Match
PTO
Only candidates who can reliably commute to the position's location in Northbrook, Illinois will be considered.
Responsibilities
Oversees the negotiation of all managed care contracting activities including but not limited to:
All for fee-for-service (FFS) agreements
All "ad-hoc" individual case agreements in accordance with policies and standards.
Negotiating complex managed care contracts and securing optimal reimbursement rates that maximize utilization and increase value.
Lead and Direct all strategic activities associated with negotiating, implementing, and maintaining complex managed care contracts and relationships with third party entities.
Work within an evolving business line to coordinate contract negotiation, implementation, and administration for Client's new healthcare services and solutions.
Monitor and analyze performance of third-party payer agreements including profitability, volume, strategic initiatives and payer/provider compliance issues Establish and maintain a system of reviewing and assessing changes in the Federal and or State regulations in regard to Managed Care contracts
Achieve and maintain a full understanding of Medicare and or Medicaid pricing reimbursement and structure for both Payors & providers.
Partner with the management team to identify, develop, and implement appropriate approaches, processes, and tools that elevate the analytics group.
Lead the implementation of managed care contracts with internal departments to develop and maintain systems to disseminate contract information.
Lead and manage the contract terms and commitments to assure all deliverables are adhered to and take proactive measures before key milestones are missed.
Work with corporate and field on any reimbursement issues and brings exceptions or non-standard requests to the attention of senior management where appropriate.
Maintain communication regarding third party participation, contract compliance, and any other operational issues or opportunities.
Review Third Party medical adherence Contracts to ensure operational requirements can be met and implemented.
Negotiate, analyze and model current, proposed, and final pricing terms for payors in accordance with pricing standards.
Lead the development and implementation of an annual strategic plan for third party payer contracting, including the continued development of opportunities and implementation of pricing strategies and contract language standards.
Monitor the technical links between the Third-Party Provider and data tracking systems to assure reported issues are properly captured, reported, prioritized and managed to closure.
Work with appropriate internal and external parties to load and update new/existing location, market, and provider information.
Manage and audit the loading and updates of pricing and reimbursement terms to ensure contract compliance and appropriate profit and reimbursement.
Perform additional duties as assigned.
Requirements
Bachelor's degree, required
5 years in a similar role, required.
5 years monitoring and analyzing performance of third-party payer agreements including profitability, volume, strategic initiates, and payer/provider compliance issues, required
Ability to work within an evolving business line to coordinate contract negotiation, implementation, and administration for Client's new healthcare services and solutions.
Expertise in managed care contracts of healthcare services, and their respective business issues and potential opportunities.
Benefits
Health
Dental
Vision
401K & Company Match
PTO
