Are you a strategic leader passionate about managed care and innovative healthcare solutions? Join our dynamic team as the Manager of Managed Care Contracting, where you'll play a pivotal role in negotiating and implementing commercial, government, and value-based payer contracts. You’ll drive financial outcomes, ensure compliance, and foster strong payer relationships while contributing to the organization’s mission of delivering top-tier healthcare. This position offers the flexibility of a hybrid work environment, with 2-3 days in-office weekly.
Key Responsibilities
In this critical role, you will:
- Negotiate and Execute Contracts: Manage agreements, amendments, Letters of Agreement (LOAs), and single-case agreements (SCAs) to meet financial goals and operational efficiency.
- Oversee Value-Based Contracts: Negotiate and monitor performance, ensuring alignment with organizational objectives.
- Financial Analysis: Prepare financial feasibility models and evaluate the impact of regulatory changes on contracts.
- Support Operational Growth: Assist in creating business plans and budgets for new services.
- Ensure Compliance: Monitor payer adherence to contractual and regulatory terms.
- Customer Relationship Management: Build and maintain strong, collaborative relationships with payers and internal stakeholders.
- Market Awareness: Stay informed on innovative reimbursement methodologies, including bundled payments and performance-based incentives.
- Claims Resolution: Draft and facilitate claims settlement agreements as needed.
Qualifications
- Education: Bachelor’s degree in Health Administration, Business, Finance, or a related field required.
Experience:
- 3-5 years of progressive leadership experience in healthcare.
- Preferred background in Academic Medical Centers, Multi-Hospital Health Systems, or Managed Care Organizations (MCOs).
- Demonstrated expertise in healthcare analytics and medical economic modeling.
Skills and Abilities:
- Strong understanding of hospital and physician reimbursement methodologies (e.g., DRG, APC).
- Knowledge of billing/coding terminology (e.g., ICD-10, CPT) and hospital/physician practice accounts receivable management.
- Expertise in payer contracting, credentialing, and provider enrollment.
- Proficiency in Microsoft Office (Excel, Access, Word, PowerPoint).
- Collaborative problem-solving skills and ability to liaise between departments like Managed Care and Revenue Cycle Management.
- Commitment to excellence and superior customer service.
Join our team and make a meaningful impact in healthcare. Be part of a culture that values collaboration, continuous improvement, and delivering exceptional service.
