Senior Contract Manager-Managed Care (Hybrid position)

We have an exciting opportunity to join our team as a Senior Contract Manager-Managed Care.

In this role, the successful candidate as the Senior Contract Manager-Managed Care assists with the development and implementation of managed care strategy for NYU Langone Hospitals Tisch, Orthopedic, Brooklyn Long Island and Long Island Community Hospital at NYU Langone Health including all Article 28 freestanding facilities such as the Perlmutter Cancer Center, NYU Langone Home Care and the Long Island Community Hospital Hospice.

Negotiate hospital contracts with the managed care plans that are profitable. Ensures contracts are administered and implemented in accordance with the negotiated terms of the agreement.

Acts as a liaison between the managed care plans and various departments within the hospital such as Patient Access / Insurance Clearance, Care Management, Revenue Cycle and hospital administration to resolve Managed Care contract compliance and interpretation issues, reimbursement disparities and managed care procedures and policies.

Works with outside legal counsel to improve contract language and address Managed Care payers policy concerns that impact the contract performance

Job Responsibilities :

1. Acts as a liaison between the hospitals and the Managed Care plans on all matters related to contracting with managed care payers ( Commercial payer, Medicaid Managed Care plans, Medicare Managed Care Plans and PPOs, etc.).

2. Negotiate hospital contracts with the Managed Care payers and solicit suggestions and recommendations from hospital senior management pertaining to managed care contracting.

Respond timely to request from various hospital areas to negotiate single case agreements on behalf of patients where the hospital does not have an agreement.

3. Provide continuous and timely feedback on open Managed Care issues to senior leadership.

4. Review contract language with applicable hospital departments and senior leadership and recommend changes and partner with outside legal counsel to craft the contract language and facilitate implementation of the contract language with the payers.

5. Coordinate and conduct educational sessions on various managed care plans policies, procedures and billing requirements to key departmental staff.

6. Work closely with hospital finance regarding the financial specifications of each Managed Care contract.

7. Represents the Hospitals at Joint Operating Committees with the Managed Care payers.

8. Work in collaboration with the hospital departments such as Revenue Management Initiatives (RMI) to ensure charges are appropriately set to maximize reimbursement and mitigate lesser of contract terms in the Managed Care contract.

Work with RMI to ensure the charge master is configured consistent with the contract terms and services provided at the health system.

Keep abreast of industry standard billing guidelines such as NUBC, CMS, NYS DOH and other regulatory agencies. Partner with RMI to ensure back end claim functions payer’s alternate logic are working seamlessly to improve the billing functionality.

9. Review Joint Operating Committee claim files provided by Revenue Cycle to the documents are clean and accurate before submission to the Managed Care payers.

Actively engage the payers to ensure the contract performs consistent with the Managed Care agreement and collect payment on underpaid claims timely.

10. Partner with Revenue Cycle Systems to ensure negotiated contract terms can be administered in Epic and contracted rates and terms are accurately loaded in Epic.

Claims are billed consistent with the Managed Care agreement revenue code, CPT4 code, modifiers, MS or APR DRG, negotiated rates and the payer’s policy.

Audit the Managed Care contract load in EPIC timely.

11. Serve as a liaison with Patient Access / Insurance Clearance and the Managed Care payers to expedite authorization requests for urgent procedures across the health system.

Ensure each hospital department is maximizing electronic connectivity with the Managed Care payers for admission notification, payer’s portal, etc.

12. Collaborate with the Managed Care payers and Care Management and Social Work at each facility to facilitate post-acute care authorization requests to alleviate throughput in the emergency department and the inpatient acute setting.

Improve the daily concurrent review process by implementing remote Epic EMR access to reduce lack of information denials and improve the communication between the payers and the hospital.

13. Assist the Denials and Appeals management team to expedite payer’s response to administrative, medical necessity and DRG downgrade appeals in a timely manner.

Ensure each Managed Care contract has an external appeal agent and implement a workflow between the appeals and denials management team and the payer to manage the appeals process.

14. Monitor Managed Care policies on a monthly basis by reading the payer’s monthly newsletter or payer alerts to stay abreast of payer’s policy changes and determine the impact on the Managed Care contract terms.

15. Oversee Contract Managers to set direction and ensure goals are achieved in accordance with the direction of the hospitals.

16. Respond to various requests from hospital leadership, hospital operations team or payers with accurate information in a timely manner

Minimum Qualifications :

To qualify you must have a Bachelors degree in Health Care, Public Health or Business Administration.

3-5 years of progressive health care experience in managed care.

Preferred Qualifications :

Masters degree in Health Care Administration, Public Health Administration or Business Administration. Ten years of progressive health care experience with 3-5 years experience in managed care.

Qualified candidates must be able to effectively communicate with all levels of the organization.

NYU Langone Health provides its staff with far more than just a place to work. Rather, we are an institution you can be proud of, an institution where you'll feel good about devoting your time and your talents.

NYU Langone Health is an equal opportunity and affirmative action employer committed to diversity and inclusion in all aspects of recruiting and employment.