Job Details

POSITION QUALIFICATIONS/REQUIREMENTS:

• Education and/or Experience: Bachelor’s degree in healthcare or business preferred; plus 5 to 10 years’ experience with managed care.
• Minimum of five years leadership experience, with strong interpersonal skills and the ability to communicate effectively with and build effective working relationships throughout all levels of the organization as well as with outside vendors and providers.
• Ability to organize and present data effectively.
• Ability to interpret and explain complex rules, regulations, policies, and procedures; make decisions on a variety of complex matters in accordance with established policies.
• Strong analytical skills, creative thinking, and ability to pay attention to detail.
• Strong PC skills, including proficiency in Microsoft Office Suite, Netsmart EMR, and other applications as needed.
• Colleague must sign a Business Protection Agreement.

ORGANIZATIONAL SUPPORT:

• Demonstrate professional accountability
• Advocate for positive change
• Display customer service excellence
• Utilize all communication technologies and practices effectively
• Participate in improving performance and quality
• Manage resources effectively

JOB DUTIES/RESPONSIBILITIES:

1. In collaboration with leadership, identifies appropriate contracting and re-contracting opportunities and initiates discussions with key constituents.
2. Creates and maintains high level contacts with existing and potential contracting partners.
3. Collaborates with managed care organizations and internal stakeholders to gain a thorough understanding of payer-specific requirements, reimbursement logic, and limitations. Ensures contracting efforts remain aligned with program goals.
4. For new relationships or service lines, performs business and market analysis to determine viability of contracting.
5. Leads contract discussions with managed care organizations, including rate and language negotiations in accordance with established guidelines. Leads development of rate and language proposals. Collaborate with internal staff on modeling of rate proposals. Ensures contract terms can be administered and monitored in a cost-effective manner. Effectively interfaces with management, finance, clinical, operations, and administrative staff to ensure contract negotiations are completed in accordance with critical dates and within approved financial parameters.
6. Manages all aspects of the contract life cycle. Collaborates to assemble and gain an understanding of payer specific data, operational issues, and business review. Implements executed contracts, communicates contract changes internally, maintains appropriate documentation, reviews contract performance reports and makes appropriate recommendations.
7. Facilitates problem solving of escalated contractual and operational issues through collaboration with managed care organizations and internal stakeholders. Identifies and communicates opportunities for process improvement with managed care organizations and internal stakeholders.
8. Coordinates with an analytical team to ensure contractual terms, including payer-specific requirements, reimbursement logic, and limitations are understood and appropriately included in any modeling systems. Serves as the expert on all terms of the payer contract for both internal and external parties.
9. Participates in special projects as needed, including evaluating feasibility of program development as it pertains to payer operational requirements and reimbursement policies
10. Stays abreast of changing healthcare landscape to maintain an awareness of competitor services and reimbursement models, as well as opportunities for improvement in the financial and operational components of managed care contracts. Leads discussions pertinent to contract performance, market changes, market intelligence, and strategic decision-making.
11. Performs miscellaneous job-related duties as requested.

PHYSICAL REQUIREMENTS:

While performing the duties of this job, the colleague is required to sit for long periods of time. Manual dexterity and visual acuity are necessary to type using a computer keyboard, visually read information off a computer monitor and paper documents. Requires ability to orally communicate information over the telephone and in person and hear responses. Requires ability to lift/carry up to 10 lbs. 

LOCATION:

This is a remote position.  There will be occasional travel to throughout the Empath Health footprint.          

Empath Health values diversity as it strengthens our community and care. We embrace the diversity of cultures, thoughts, beliefs and traditions of our employees, volunteers and people we are honored to serve across our network. Our diverse staff reflects our community and each day, we work to be respectful, sensitive and competent with each other and those in our care. In every journey, we are dedicated to achieving comfort, dignity and exceptional care. Those of all backgrounds are welcome and encouraged to apply with us or seek our care and services.

Our commitment to patient, client, staff and volunteer safety is a cornerstone of a High Reliability Organization with a focus on zero harm. Participation in the seasonal influenza is a condition of employment and a requirement for all Empath Health employees.

Providing compassionate, full life care is an honor we take seriously at Empath Health. Join our team and make a positive impact in the community!