Location: Miami,FL, USA
PRIMARY FUNCTION: Responsible for contract management of hospitals, medical groups and physicians. This includes contract language review, negotiating contract terms and rates, data analysis, credentialing and system updates. The Senior Contract Manager will also assist with evaluating prospective managed care plans and remaining compliant with State and Federal Regulations. This position will support the VP, Revenue Cycle in strategic solutions and other duties as assigned.
QUALIFICATIONS: Bachelor's degree in Healthcare Administration, Business Administration or related field. Minimum of 7 years healthcare related experience required.
ESSENTIAL FUNCTIONS: (This list does not encompass all duties that may be assigned.)
* Perform contract language review and support in negotiating language changes/terms/carve outs/ provisions with payors to maximize reimbursement, mitigate risk and streamline administration
* Report and analyze data for managed care contract negotiations and monthly financial performance, including Capitation, Risk, Gain share, Pay for Performance, Underpayments
* Develop strategic solutions through data- driven modeling and analysis.
* Maintain contract renewal schedule to ensure timely negotiation of contracts
* Perform random audits to ensure provider and payor compliance with contract terms and follow through on discrepancies.
* Remain current on state and federal regulations that impact contract performance
* Identify contracting opportunities with existing and prospective payor agreements
* Maintain accurate Charge Master and timely updates of contracts in system
* Meet with VP, Revenue Cycle weekly to review managed care contract matters
* Perform any other duties as assigned by VP, Revenue Cycle
* Oversight of contract system configuration to ensure accurate claims adjudication
PERFORMANCE REQUIREMENTS:
* Negotiate rates and terms for hospitals, medical groups and physicians
* Perform rate evaluation based on data- driven modeling and analysis
* Evaluate contract performance and compliance.
* Develop and maintain strong relationships with payors and internal customers
* Adhere to organizational information security policies and protect all sensitive information including, but not limited to, ePHI, PHI, and HIPAA in accordance with organizational policies, local, state and federal regulations
* Attend required meetings and trainings.
* Perform special projects and other duties as assigned.
KNOWLEDGE, SKILLS AND ABILITIES:
* In depth understanding and application of contract compliance, parameters, reimbursement methodologies, contract language and performance.
* Knowledge of HMS/Medhost Contract Management System
* Knowledge in Risk and Value Based Contracting
* Effective strategic planning and organizational skills
* Knowledge of Medicare, Medicaid, Medicare Advantage and Commercial plans
* Proficient in research, analysis, modeling and interpretation of financial data and trends
* Knowledge of reimbursement methodologies, including DRG, HCPCS, CPT, ICD-10
* Advanced Microsoft Office Skills
* Effective oral and written communication and negotiating skills
* Ability to manage multiple priorities and projects effectively
* Strong interpersonal and teamwork skills
* Ability to influence others