This list contains only the countries for which job offers have been published in the selected language (e.g., in the French version, only job offers written in French are displayed, and in the English version, only those in English).
Corporate level manager responsible for deploying and contributing to strategic and tactical initiatives for negotiations with national and regional payors. Manages execution of contracting initiatives for integrated delivery system to drive positive financial trend and to achieve an appropriate market price point on behalf of health system's acute care, ancillary and professional providers. Responsible for securing negotiations of all contractual provisions, implementing appropriate financial reimbursement models, and supporting operations by collaborating with clinical and operational staff to preserve revenue and address payer imposed challenges. Implement strategic and tactical initiatives to achieve organization and department goals.
Job Responsibility:
Execute, contribute and manage complex legal, financial and operational contract language negotiations in concert with the Director of Managed Care or independently as applicable to the negotiation
Execute contracting strategies for all service lines in Memorial Hospitals, MHS employed physicians, transplant programs, and ancillary services of the fully integrated healthcare delivery system and its joint owned or joint ventured entities for fee for service and value based arrangements
Direct and analyze financial performance, reports and models, quality metrics and cost savings for negotiations with national and regional payors
Plan and monitor activities of staff and team members including hiring, orienting, training, mentoring, continuing education, evaluating, coaching and disciplinary actions
Enhance, estimate and preserve net revenues
Assure financial viability of contracts through financial analysis and forecasting in conjunction with Financial Analyst(s), contract negotiations and issue resolution
Execute strategies and guides operations to protect and build market share
Interface with managed care plans on claim reconciliations, trended issues and operational projects
Determine root cause and seek resolution
Evaluate payor assessments of overpayments and effectively dispute or resolve for settlement
Escalate, monitor and manage operational issues from Managed Care Revenue Optimization, Accounts Receivable Management or Joint Operations for solution or potential dispute resolution
Advise and support optimal operational performance by collaborating with other departments and facility leadership impacted by payer organizations policies for authorization, denials, discharge planning, pharmaceutical programs
Communicate, coordinate and research to collect information to resolve issues
Research new business opportunities (relationships, pricing, services, structures, operations, quality)
Respond to insurance industry activities, healthcare reform, payer strategies, emerging market demands and legislative considerations and changes to the managed care industry to maintain and competitive position
Monitor department operations, activities, resources to meet budget and goals
Requirements:
Bachelors
Five (5) years contracting experience with three (3) years contracting for hospital, professional services, ancillary facilities or specialty networks