Managed Care Contract Performance Specialist

Managed Care Contract Performance Specialist

Summa Health - 1077 Gorge Blvd, Akron, OH

Full-Time / 40 Hours / Days

Summary :

Monitor contract reimbursement to ensure Summa Health System is realizing the intended negotiated contract rates. Proactively monitors proposed changes in the payer payment policies that will materially impact the contract yield, retroactive contract monitoring to investigate underpayments / overpayments, and working with the payers to resolve issues weakening contract yield.

Formal Education Required :

a.Bachelors Degree in Accounting, Finance, Operations Management, or Health Care Administration

Experience & Training Required :

a.At least 4 years of related accounting / finance / managed care

b.At least 4 years of related health care experience

c.Payer / provider contract review experience preferred

d.Functional skills and experience with Microsoft Office Suite (Excel, Word, Access and Power Point) to model effective financial presentations.

e.Billing and Revenue Cycle experience preferred and Certified Professional or Outpatient Coder preferred.

f.Epic billing and reporting experience preferred.

3.Other Skills, Competencies and Qualifications :

a.Strong analytical skills and abilities.

b.Ability to communicate and present financial and operational analysis concepts to management and staff.

c.Ability to learn new reporting software and create standard reports from diverse data layouts.

d.Ability to work independently within management guidelines.

e.Possess excellent verbal and written communication s

f.kills.

g.Ability to understand contract language, requirements, and responsibilities of all those party to the contract.

h.Ability to understand provider (facility and professional) claim billing and payer reimbursement methodologies.

i.Ability to research payer payment policies and determine material reimbursement changes with proposed payment policy changes.

j.Assumes personal accountability for the preparation and completion of projects and analysis.

k.Ability to organize multiple issues, keeps them updated, and communicates their requirements.

l.Possesses basic knowledge of Managed Care contracting processes, terminology and provisions.

m.Ability to understand healthcare / managed care issues / trends.

n.Ability to understand hospital operations as it relates to managed care.

o.Population Specific Competency : ability to effectively interact with populations of patients / customers with an understanding of their needs for self-respect and dignity.

p.Research the medical, administrative and reimbursement policies for contribution of contractual intentions and the Payer negotiation discussions.

q.Ability to review competitive intelligence and payer polices for contribution to payer amendments and negotiations.

4.Level of Physical Demands :

a.Sedentary : Exerts up to ten pounds of force occasionally and / or a negligible amount of force frequently.

$33.66 / hr - $50.49 / hr

The salary range on this job posting / advertising is base salary exclusive of any bonuses or differentials. Many factors, such as years of relevant experience and geographical location are considered when determining the starting rate of pay.

We believe in the importance of pay equity and consider internal equity of our current team members when determining offers.

Please keep in mind that the range that is listed is the full base salary range. Hiring at the maximum of the range would not be typical.