ESSENTIAL FUNCTIONS
- Develop and maintain positive, effective relationships with internal and external customers and serve as the contracting liaison between contracted Payors and providers.
- Lead contract analysis and negotiations with Payors on behalf of providers including rates, payment methodologies, contract language and value- based payment programs in accordance with internal control processes for contract review, approval and signature.
- Lead development of Payor reimbursement analyses that can be routinely updated and maintained as a baseline for strategies to maximize health plan reimbursement and ensure payment integrity.
- Research and make recommendations to executive leadership in regard to payor contracting opportunities in new and existing geographic service area.
- Ensure compliance in all business and contractual relationships
- Identify and communicate trends and/or potential issues to market leadership and HOPCo management team.
- Lead development of infrastructure and analysis for strategic projects including rate transparency, payment validation and coordination with Revenue Cycle Management, payor contracting strategy including value based care glidepath.
- Other duties and responsibilities as assigned.
The job holder must demonstrate current competencies for job position.
EDUCATION
- Bachelor’s Degree in Business, Mathematics, Finance or Healthcare Administration required.
EXPERIENCE
- Proven working knowledge of provider financial issues, complex contracting options, financial/contracting arrangements and regulatory requirements.
- 7-10 years related experience and comprehensive level of analytic and negotiating skills with successful track record supporting contract negotiations with payors.
- Strong communication, critical thinking, problem resolution and interpersonal skills.
- Solid understanding of industry dynamics required.
REQUIREMENTS
- Familiarity with managed care products and services, medical cost trend analysis, including analysis of physician contracts, utilization, and costs.
- Must have prior experience working with managed care contracting modeling.
- Familiar with a variety of concepts, practices, and procedures in the field of managed care.
- Must be able to problem solve and come forward with recommendations.
- Must be able to stay on task with minimal supervision.
- Excellent critical thinking, troubleshooting, and analytical skills.
KNOWLEDGE
- Knowledge of payor reimbursement.
- Managed care contracting.
- Market and industry knowledge.
SKILLS
- Strong verbal and written communication skills.
- Strong organizational skills and careful attention to detail.
- Advance computer skills.
ABILITIES
- Ability to analyze problems and interpret information.
- Able and to prioritize and reprioritize, as necessary.
- Ability to work independently, and as part of a team.
- Ability to multi-task, manages multiple projects, and meets tight deadlines.
ENVIRONMENTAL WORKING CONDITIONS
- Normal office environment or Remote. Some travel within community.
PHYSICAL/MENTAL DEMANDS
- Requires sitting and standing associated with a normal office environment.
- Some bending and stretching required.
- Manual dexterity using a calculator and computer keyboard.
ORGANIZATIONAL REQUIREMENTS
- HOPCo Mission, Vision and Values must be acknowledged and adhered to
- OSHA Requirements and training to include: *Safety Training
This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve.
Bachelor's degree in Business, Mathematics, Finance, or Healthcare Administration; 7-10 years related experience with payor contracting; managed care contracting modeling; strong analytical and negotiation skills; minimal supervision.
Key Responsibilities
- negotiating payor contracts
- leading reimbursement analyses
- ensuring compliance
Job Details
- Category: Business Operations
- Seniority: Senior Level
- Commitment: Full Time
- Workplace: Remote — Arizona, United States
- Languages: English
About The CORE Institute
A healthcare organization providing orthopedic services and managing payor contracts. — Industry: Healthcare