Managed Care Contracting & Operations Coordinator (Temporary FT)
Blanchard Valley Regional Health Center

Job Info

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PURPOSE OF THIS POSITION

This position is responsible for negotiating designated managed care contracts with managed care companies and health plans, including HMOs, PPOs, and other products. The negotiation role includes developing, evaluating and responding to rate structures and rate levels as well as contract language for the contracts. The position interacts and negotiates with leaders and contracting representatives from external parties, health plans and payers, as well as internal leaders. The position also participates with the Director of Managed Care & Payor Strategy in the development of contract language, rates and negotiation strategy for tier 1 payers. The position serves as key liaison between BVHS entities and departments and payers regarding contract implementation, ongoing contract compliance, payer operational and contract compliance issues and contract negotiations. The position maintains databases of and provides managed care contracted rates and terms by payer and product to support revenue cycle, patient estimator, strategic pricing tools and contract management tools operated by other BVHS entities and departments. The position also leads special projects related to the operational and developmental areas of the department or the organization.

JOB DUTIES/RESPONSIBILITIES

Duty 1: Responsible for the negotiation of designated "tier 2" managed care contracts to achieve strategic contracting goals. Develops strategy for contract relationships, responds to payer contract opportunities, reviews contract requirements, terms and conditions, and researches payer viability and legitimacy when warranted. Develops and analyzes the rates and the structure/methodology for proposals or counterproposals; reviews and analyzes the impact of payer contract language and counter-proposes and negotiates BVHS-acceptable contract language. Independently meets, conferences and communicates with specified health plans and payers for negotiation of rates and language, including development of negotiation agendas. The position makes recommendations to the Director, Managed Care for final approval of these contract negotiations, as well as recommendations regarding new or terminating relationships for designated payers. "Tier 2" contracts are medium to low volume, entity specific, behavioral health, etc., as designated by the Director, Managed Care.

Duty 2: The position participates with the Managed Care Director in the development and negotiation of contract language, rates and negotiation strategy for tier 1 (high volume) payers.

Duty 3: Serves as key liaison between BVHS entities and departments and payers regarding ongoing contract compliance, payer operational and contract compliance issues and contract negotiations. Researches and intervenes to resolve systemic billing/payment, utilization review or other operational issues with contracted payers for any BVHS entity, working in cooperation with credentialing, Patient Revenue Cycle, utilization review, or CCS billing areas. Reviews payer provider directories and provides information to support payers in appropriately including BVHS providers and services in provider directories for enrollees.

Duty 4: Leads contract implementation activities for all payers for BVHS entities and physicians. Creates, maintains and distributes timely, accurate and detailed databases for contract management (participation status, rates, contacts, renewals, contracting process tracking, etc.) to ensure BVHS constituents have information needed to perform their jobs as relates to billing and managed care. Disseminates contract terms and payer notices to support BVHS' compliance with contract terms, rules and requirements, and interacts with internal and external parties regarding rates and terms, charge increase notifications and limitations, and resolving contract provisions issues and disputes.

Duty 5: The position maintains databases of and provides managed care contracted rates and terms by payer and product to support revenue cycle, patient estimator, strategic pricing tools and contract management tools operated by other BVHS entities and departments.

Duty 6: Contingent on the availability of appropriate reporting from Cerner, provides financial analyses of contract historical performance and rate proposals and extracts reports for contract monitoring.

Duty 7: Provides operational, data management and analytical support to Director of Managed Care and the functions of the managed care department, including data management activities related to population health and value-based payment initiatives. Leads special projects related to managed care. Leads interdepartmental educational and operations improvement activities related to managed care.

Duty 8: Acts as Certified Application Counselor for BVMP marketplace enrollment and performs other similar patient access functions as may be required from time to time.

REQUIRED QUALIFICATIONS

• Bachelor's degree in business or health-related field, or equivalent relevant experience required.
• Four years of experience in managed care, contract negotiations, insurance plan network management, or healthcare billing and analytics required.
• Excellent organization, problem solving, time and work process management skills.
• Strong database management and analytical skills.
• Strong problem-solving skills and operation improvement orientation.
• Excellent interpersonal and communication skills require, including ability to handle challenging communications when necessary.
• Ability to meet deadlines while managing multiple tasks.
• A valid driver's license is required (if you do not have a valid Ohio driver's license you must obtain one within 30 days of your residency in the state). You must also meet BVHS's company fleet policy and insurance company requirements, and any other requirements that may be required to operate a vehicle.

PREFERRED QUALIFICATIONS

• Master's degree in business or healthcare administration related field preferred.

PHYSICAL DEMANDS

This position requires a full range of body motion with intermittent activities in lifting, bending, squatting, kneeling, twisting and standing. The associate will be required to sit for four hours and walk three hours per day. The individual must be able to lift twenty to fifty pounds and reach work above the shoulders. This position requires corrected vision and hearing in the normal range. Individual must have excellent verbal communication skills to perform daily tasks. This associate must be licensed to operate a motor vehicle.

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