What are the responsibilities and job description for the Managed Care Contract Manager position at Valley Presbyterian?
Job Summary :
Under the direction of the Director of Managed Care, the Contract Manager will manage the compilation, reporting and analysis of data, participate in negotiating, reviewing, and redlining agreements, track all contracts and amendments in the VPH Contract Management System and track all letter of agreements (LOAs) via SmartSheet. This includes, but is not limited to negotiating and papering LOAs, financial models related to managed care contract negotiations, as well as analysis in support of other managed care contracting activities and creating presentations for upper management review. The Contract Manager will conduct quantitative and qualitative analyses on a broad array of issues across functional areas.
Experience / Qualifications :
5-7 years of healthcare experience in Managed Care contracting or as a Financial Analyst or similar position
Previous Managed Care and capitation-related experience to include understanding the DOFR is highly desirable
Experience with Letters of Agreement, Hospital, and Ancillary contracting
Previous contract lifecycle management experience is highly desirable
Advanced proficiency in MS Office applications, including fluency in the use of advanced Excel formulas, pivot tables, and database queries, Word, and PowerPoint are required
Familiarity with healthcare data, FinThrive and Meditech strongly preferred
Strong relationship building and management abilities strongly preferred
Excellent organizational skills and attention to detail
Ability to analyze and resolve complex issues, both logical and interpersonal
Effective verbal and written communication skills and effective presentation skills
Self-motivated, team player, cooperative, flexible, and creative
Education :
Bachelor's degree in health care, Accounting, or Finance field is preferred
Licensures / Certification :
Must successfully complete and maintain LA City Fire Card certification at the time of hire or within the first 30 days of employment
Duties and Responsibilities :
Researches and analyzes data from a variety of sources. Prepares and designs analytical reports and prepares complex financial trends and data analysis reports from those sources. Verifies accuracy of data.
Provides analytical support of capitation financial and statistical data from the external Management Services Organization (MSO).
Performs contract modeling in FinThrive.
Ability to identify, manage, and resolve Managed Care operational issues to include escalated issues related to contract negotiations, language review and redlines, renewals, letters of agreements (LOAs), and settlements with payors.
Works with providers, health plans, IPAs, medical groups and TPA.
Performs Contract Exclusion audits as applicable.
Tracks all LOAs on the VPH LOA tracking log and reports weekly status.
Assists the Director of Managed Care in loading contracts and renewals in the VPH Contract Management System.
Develops a thorough understanding of the hospital's capitation and managed care contracts.
Participates in quarterly joint meetings with IPAs and TPA to improve risk pool performance.
Reviews claims data to ensure accuracy of adjudication and payment.
Serves as a key resource and works collaboratively with all stakeholders and the Managed Care Leadership.
Participates in projects of moderate to complex scope as assigned.
Completes ad-hoc reports and special project assignments as it relates to Managed Care operations.
Keep a pulse on the job market with advanced job matching technology.
If your compensation planning software is too rigid to deploy winning incentive strategies, it’s time to find an adaptable solution.
Compensation Planning
Enhance your organization's compensation strategy with salary data sets that HR and team managers can use to pay your staff right.
Surveys & Data Sets
What is the career path for a Managed Care Contract Manager?
Sign up to receive alerts about other jobs on the Managed Care Contract Manager career path by checking the boxes next to the positions that interest you.
