Sr. Manager, Network & Contracting

CarepathRx transforms hospital pharmacy from a cost center into an active revenue generator through a powerful combination of technology, market-leading pharmacy services and wrap-around services.

Job Details :

The Sr. Manager, Networking and Contracting serves a critical role by maintaining continual health plan contract adherence and ongoing revenue cycle management optimization.

This role will serve as an important bridge between our managed care and our revenue cycle management teams by effectively translating key contract terms into the core revenue cycle management systems.

Responsibilities

Evaluates and documents department needs and all aspects of business processes both operational and financial, including current process analysis;

and proposed revisions to optimize business processes.

Assist in designing and executing solutions that meet System's / Divisions' strategic objectives

Assures quality of information technology solutions and system upgrades through business case and application-level testing;

validates test results to initial business needs.

Work with Information Services staff to design, test and deploy appropriate hardware solutions, connectivity requirements and interface solutions, as appropriate.

Play a key role in month end close operations.

Builds and maintains system maintenance files.

Create and maintain fee schedules by sevice area

Develop, implement, and oversee procedures to ensure coding accuracy.

Manage the reconciliation of all discrepancies found applicable system records in a timely manner, and provide reports to management, as appropriate.

Conduct quality assurance and accuracy audits of system files

Provide documentation and training as needed.

Provide service according to the expectations of policies / procedures and standards developed around the revenue cycle department.

Manage routine & special projects which may require oversight of other departments' work and coordination of a wide variety of functions.

Develop and maintain working relationships with Revenue Cycle departments, and external contacts as appropriate.

Maintain policies and procedures of the team / department as needed.

Identify departmental needs and report to management as appropriate

Meet deadlines and turnaround times set by department leadership.

Provide guidance to peers and serve as reference point for questions as needed.

Qualifications

Bachelor's degree in Data Management, Information Systems, Economics, Mathematics, Statistics, or a related field or at least five years relevant industry experience.

Good computer skills are a given, with expert industry knowledge.

Must possess strong project management skills, solid analytical and problem-solving skills, and have meticulous attention to detail.

Able to communicate technical information to non-technical people.

Must possess strong project management skills, solid analytical and problem-solving skills, and have meticulous attention to detail.

Experience in health care insurance or health care.

Experience with CPR+, HCN, and Caretend is preferred.

CarepathRx provides equal employment opportunity to all qualified applicants regardless of race, color, religion, national origin, sex, sexual orientation, gender identity, age, disability, genetic information, or veteran status, or other legally protected classification in the state in which a person is seeking employment.

Applicants encouraged to confidentially self-identify when applying. Local applicants are encouraged to apply. We maintain a drug-free work environment.

Applicants must be eligible to work in this country.