Location: Worcester,MA, USA
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Exemption Status:
Exempt
Schedule Details:
Monday through Friday
Scheduled Hours:
8:30am-5pm
Shift:
1 - Day Shift, 8 Hours (United States of America)
Hours:
40
Cost Center:
99940 - 5876 Payer Contracting
This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.
Everyone Is a Caregiver
At UMass Memorial Health, everyone is a caregiver - regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 16,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day.
Responsible for the implementation and renewal of managed care contracts for the medical center and physicians. Assists in the renewal of ancillary service and member hospital managed care contracts.
Major Responsibilities:
* Responds to all inquiries relating to managed care contracts from medical center personnel, physicians and/or physicians' office staff. Interprets contract language and ensures that the terms of contracts are communicated and implemented accurately within the system. Resolves issues relating to health plan credentialing, claims payment, referral management, and various administrative issues.
* Coordinates with Managed Care Provider Relations staff communication of contractual requirements, updates on policy and operational changes and other contract-related information to various departments within the organization.
* Coordinates site visits required for credentialing for new and existing programs.
* Acts as primary liaison with managed care plans in addressing operational issues arising under the managed care contracts. Meets regularly with representatives from the managed care plans to ensure contractual obligations are met and to resolve issues raised by UMass Memorial Medical Center and Umass Memorial Medical Group personnel.
* Manages contracts to ensure compliance and, with input from the Director, Legal, Finance, and other departments as appropriate, is responsible for renewing and renegotiating contract terms. Assists with financial analysis and negotiation of risk contracts. Assists in contracting for ancillary services, including home health & hospice and MRI services, and affiliate hospital risk contracts.
* Helps resolve technical and operational problems. Evaluates the impact of solutions to ensure goals are achieved.
License/Certification/Education:
Required:
* BS degree or equivalent in Business, Health Care Administration, or Managed Care Administration.
Experience/Skills:
Required:
* Five years' experience in hospital, physician office, clinical or managed care setting; thorough understanding of clinical operations, health care terminology, and current market conditions.
* Three years direct managed care-contracting experience, with emphasis on analyzing and negotiating risk contracts and thorough understanding of managed care financial arrangements and boilerplate negotiations.
* Experience with risk contracting preferred.
* Good knowledge of commercial Medicare Advantage and Managed Medicaid markets preferred. Excellent verbal and written communication skills.
* Proficiency with Microsoft Office applications.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.
We're striving to make respect a part of everything we do at UMass Memorial Health - for our patients, our community and each other. Our six Standards of Respect are: Acknowledge, Listen, Communicate, Be Responsive, Be a Team Player and Be Kind. If you share these Standards of Respect, we hope you will join our team and help us make respect our standard for everyone, every day.
As an equal opportunity and affirmative action employer, UMass Memorial Health recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives and backgrounds. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, gender identity and expression, protected veteran status or other status protected by law.
If you are unable to submit an application because of incompatible assistive technology or a disability, please contact us at ...@umassmemorial.org. We will make every effort to respond to your request for disability assistance as soon as possible.