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Managed Care Senior Contract Manager in Knoxville, TN at TeamHealth

Date Posted: 10/16/2021

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    Knoxville, TN
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:
    10/16/2021

Job Description

POSITION SUMMARY

Assist the VP to manage and negotiate assigned Managed Care Plans including analysis of the proposed contracts, conducting financial impact studies and proposing negotiating tactics.  This position interacts with various individuals, which include corporate and division management, client hospitals, and physician leadership.

ESSENTIAL RESPONSIBILITIES

  • Assist VP to manage all aspects of the negotiation of managed care plans including, but not limited to, examination and analysis of contract documents, evaluation of the financial implications of the proposed contract, and developing negotiating tactics and strategy.
  • Perform effective and thorough financial analysis of capitation and at risk arrangements including complex CIN and ACO relationships. Develop and/ or coordinate subsequent reviews to monitor actual results. 
  • Ability to develop, review/ analyze and coordinate performance metrics
  • Thorough financial analysis of contracts including denial history and other factors that impact realized reimbursement
  • Monitor and develop existing systems to increase effectiveness and efficiency.
  • Support and promote effective communication and interaction with, including but not limited to, representatives of the billing centers, legal, operation divisions and managed care organizations.
  • Act as a liaison with hospital and facility clients in resolving managed care billing and contractual issues
  • Responsible/ accountable for maintaining information regarding managed care contracts including updates on pending expirations or proposed amendments, and file maintenance.
  • Coordinate and ensure proper loading of contract terms into IDX and ongoing maintenance so that managed care agreements can be administered in the billing system. Review requests submitted for the creation of new financial classes (FSCs) to effectively capture payer volume and billing data.
  • Responsible to provide data for and review of internal monthly managed care reports and budget development/ tracking
  • Assist/ coordinate assistance for billing and provider enrollment in research and resolution of payer issues including denials and underpayments
  • Perform payer policy and procedure review as assigned
  • Stay current on policy/ procedure changes that impact reimbursement, report such changes and address timely
  • Effective management of departmental staff as assigned
  • Manage and complete other projects as assigned by the VP.

 

Job Requirements

POSITION REQUIREMENTS

Skills:

  • The ability to interact with staff in a professional, supportive, and effective manner.
  • An understanding of proper negotiation techniques and managed care contracting experience
  • Demonstrate the capacity to utilize software applications and databases including billing systems and provider databases.
  • An understanding and application of medical billing and reimbursement procedures/practices.
  • Strong analytical ability required for effective and thorough financial analysis of new and renegotiated managed care agreements including at risk components
  • The ability to comprehend and think logically, as well as proven leadership skills.
  • Strong oral and written communication skills.
  • The ability to interrelate, teach and convey information to the staff.
  • Must have a good working knowledge of Microsoft Office software such as MS Excel, MS Word, and MS PowerPoint and ability to manage / use databases.

Education:

A bachelors degree in business or healthcare administration is preferred or equivalent education and experience.

Experience:

A minimum of 3 to 5 years of experience in managed care contracting with a payer, hospital or large multispecialty physician practice.

WORKING CONDITIONS

The work location is in a modern office environment.  The position requires occasional travel.

This position may require manual dexterity and/or frequent use of the computer, telephone, 10-key, calculator, office machines (copier, scanner, fax) and/or the ability to perform repetitive motions and/or meet production standards to comply with the essential functions. Also, may require physical and/or mental stamina to work overtime, additional hours beyond a regular schedule and/or more than five days per week.



DISCLAIMER

Cooperative, positive, courteous and professional behavior and conduct is an essential function of every position. All employees must be able to work with others beyond giving and receiving instructions. This includes getting along with co-workers, peers and management without exhibiting behavior extremes. Job functions may require personal leadership skills such as conflict resolution, negotiating, instructing, persuading, speaking with others as well as responding appropriately to job performance feedback from the supervisor. Additionally, the information contained in this job description has been designated to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this position.