Managed Care Contract Manager

Summary :

Under the direction of the Director of Managed Care, the Managed Care Contract Manager is responsible for the key components of the payer contracting process.

The payer contracts include the various terms and conditions by which Baycare’s providers which include physicians and hospitals are reimbursed for the services provided to patients.

Contracts often include pay for performance programs that incentivize providers for providing higher quality or less costly care.

Primary responsibilities of the Managed Care Contract Manager include performing contract analysis, developing payer strategy, engaging in contract negotiations, overseeing implementation, providing contract support, and serving as a subject matter expert for ongoing operational and strategic issues.

Job Responsibilities :

1) Perform contract analysis analyze contract language and financial terms, understanding how these align or differ from other payer contracts or industry standards.

Analyze performance of contract using a variety of financial and operational sources. Analyze economic, market, and regulatory conditions, to fully understand the environment in which the contract performs.

2) Develop payer strategies using the above analysis, develop negotiation strategies for maximizing financial performance, limiting operational issues, and positioning the organization for future growth and opportunity.

3) Engage in contract negotiations be the lead representative in negotiations with payers for new contracts, renewals, or other issues as needed.

Communicate and collaborate with other stakeholders on the progress of negotiations, bringing in resources where appropriate.

4) Oversee implementation take lead on ensuring post-negotiation steps are properly taken such that operational difficulties are minimized.

5) Provide Contract Support work with stakeholders on operational and financial issues as they arise. Assist in the development of an overall strategy for the managed care activities.

Serve as subject matter expert on various committees and collaborate with teammates on contracting projects and issues.

Skills and Competencies :

1) Knowledge and experience of healthcare billing and reimbursement, including experience with hospital and physician billing.

Ideally, experience with payer contracts.

2) Excellent communication and presentation skills, financial acumen, relationship building, ability to tactfully navigate healthcare environment with various key parties.

3) Proficiency in Microsoft Office applications including Word, Excel, and PowerPoint

Required Educational Experience :

Bachelor’s Degree

Preferred Educational Experience :

Master’s Degree

Required Work Experience :

5 years healthcare, managed care, provider or payer expertise

Preferred Work Experience :

Provider contracting, hospital and physician billing, pay for performance programs