Contract Manager opportunity available with a growing home healthcare company - Relocation assistance available! (onsite)
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Salary: $80,000 - $110,000 per yearA bit about us:
We are a growing home healthcare service agency in search of a Contract Manager to join our growing team.Why join us?
We offer a competitive salary, relocation assistance, and a full benefit package.Job Details
- Lead, develop and identify negotiation strategies for value-based contract negotiations with payors, while working collaboratively with internal key stake holders to execute and manage such arrangements.
- Remain current on the licensure requirements for each of the state
- Strategically develop and implement Managed Care, IPA, and Payor Contracts on a regional, and local level for multiple lines of business including commercial and governmental products.
- Review and analyze contract language and reimbursement terms in existing and potential managed care agreements and make recommendations of any modifications required for the benefit of the organization.
- Cultivate relationships and maintain strong communications with health plans and payors.
- Investigate and evaluate payor markets in different states (payor mix, reimbursement issues, and state regulatory statutes) and provide recommendations to adapt to a changing health care industry.
- Develop and analyze large and complex data sets for the creation of financial rate models, make proposal recommendations and take the lead in negotiating/renegotiating and implementing rates and terms for health plan contracts, ensuring key operational and financial objectives are met.
- Prepare financial reports to review, assess and analyze utilization trends and overall financial performance of contracts, and identify improvement opportunities with rates/contract language and develops plans and actions to carry out improvements.
- Document, organize and coordinate payor enrollment requirements and assure that an appropriate knowledge base is maintained for use in enrolling all affiliated medical practices.
- Perform continuous monitoring of the payor enrollment process to ensure compliance with standards
- Produce reports and review application tracking to track progress of onboarding and payor enrollment.
- Review onboarding list weekly to identify and address obstacles in onboarding and attend weekly onboarding calls.
- Review and refine workflows to ensure timely payor enrollment and resolution for provider related claims denials to ensure in network reimbursements.
- Provide guidance, support, and recommendations to upper management regarding department issues and resolutions.
- Perform research into specific issues as directed by Management for timely resolution.
- Remain current on industry trends, payor changes and market conditions as they relate to all plans.
The ideal candidate will demonstrate hands-on, in-depth knowledge of provider onboarding, delegated credentialing, Medicaid payor requirements, and architecture regarding the necessary requirements. This role is ideal for the self-starter who can pivot to resolve issues creatively and tactfully. The individual will also demonstrate a high level of organization skill and interact positively with all members of the Revenue Cycle team.
- Minimum BA/BS in Business Administration, Healthcare Administration degree; advanced degree preferred.
- Minimum of three (3) years of prior occupational and supervisory experience with provider enrollment and credentialing to be successful in the role. Previous management experience is a definite plus. (Preferred) 5 years’ experience negotiating and managing contracts within the health care industry working on either the health plan or provider side.
- Demonstrated strong knowledge of managed care regulations, state legislation, and laws related to health care and health care operations, as well as value based and analytical models.
- Strong negotiation and interpersonal skills; strong written, verbal, and analytical skills; motivated and a proactive strategist with the ability to adhere to deadlines; work to “get the job done”. Must be a “self-starter” with the ability to multi-task.
- Professional business sense and presentation skills; strong knowledge of reimbursement methodology types (i.e., case rates; unit rates, fee for service etc.).
- Proficient in creating and utilizing MS Excel spreadsheets and all other MS Office programs.
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Job country: United States
Category: Business Operations Specialists, All Other
Location: Tallahassee, FL, United States
Job posted 2022-06-04