Job Details

The Managed Care Contracting Specialist (MCCS) is responsible for providing analytical and database support to the Managed Care Contracting Department. The main responsibility is to maintain systems for communication of contract rates and key contract clauses across Empath for all associated provider entities.  Duties include serving as the administrator for the contracting database and developing and maintaining rate sheets/fiscal summaries and other tools to provide key contract information to the Vice President of Managed Care.   These contracts represent significant portions of Payer revenues. This position provides contract performance monitoring, rate development and evaluation, ad-hoc reporting and other analytical and operational support, including contracting database support.   

This position builds and maintains relationships internally and interacts with internal parties regarding questions on rates, contract terms, rate structure, and development and reconciliation of contract provisions. This position also manages relationships with external vendors, including routine meetings, providing references and troubleshooting issues. 

JOB DUTIES & RESPONSIBILITIES:

1. Responsible for maintaining monthly fiscal summaries showing the number of referrals by Payer for each Empath Home Health, Hospice, and Palliative Care Branch.
2. Assist with rate development for Payer entities. Utilize the various software tools that exist internally, such as Trella, and other software solutions. Proficient with reporting tools, including Power BI and other internal reporting software. Payer/Plan monitoring and maintenance. Monitor, track and report new and terminating plans, audit plans and assist in process improvement.  Support maintenance of current, termed and historical files.
3. This position will:
   1. Work with the accounting and contracting staff throughout Empath to improve the accuracy and ease of use of the fiscal summaries
   2. Communicate feedback on fiscal summaries and contract provisions to the Vice President of Managed Care as required
   3. Stay abreast of renewals, amendments and other contract changes and communicate effectively to the Vice President of Managed Care.
   4. Provide timely updates to the fiscal summaries to reflect these changes
4. Provide analytical support for the Managed Care Contracting Department, including preparation of reports in PowerPoint, for Board and Committee presentations as required.
5. Payer/Plan monitoring and maintenance. Monitor new and terminating plans, audit plans and assist in process improvement.
6. Create, maintain and update various spreadsheets and tools for reference and reporting purposes, including, but not limited to: Membership reports, capitation reports, etc. Develop and maintain process to communicate this information to appropriate parties on a routine basis.
7. Perform other projects and duties as assigned

POSITION QUALIFICATIONS & REQUIREMENTS:

• High School Diploma or GED required; Bachelor’s degree preferred.
• Minimum Two (2) years’ professional experience in Managed Care contracting with any of the following entities: Business, healthcare, physician or hospital billing or relevant work experience
• Database management, business, physician or hospital billing, healthcare or other relevant experience
• Ability to manage internal Empath data systems
• Proficient with MS Office products such as Excel, Word, Outlook, as well as some contracting specific tools and reporting programs
• Ability to interact with and work around people, professional demeanor and to provide excellent internal and external customer service

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 program 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!