OH - Payer Contracting Manager - Permanent Full Time

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Job
Description



 


Job Title:         Payer Contracting Manager



 


Pay Grade: 



 


Reports to:     CFO



 


Department/Job Code:  
1-8310-                     



 


FLSA Status:   Salaried/Exempt



 


OSHA Exposure Level: 
  


 

Job
Summary

Responsible for all stages of payer contracting
with the primary goal to maximize net revenue and ensure compliance through
commercial contracting, contract payment, recovery analysis and analysis of
government payer performance:

Directs and
manages contract negotiations with carriers and maintains these payer
relationships. Works with revenue cycle team to monitor collection of
appropriate payments for all agreements, as well as improve contract
reimbursement and timely payments. Assists with the integration of acquired
practices by working with the credentialing analyst to ensure new physicians
transition under carrier contracts in a timely manner. Analyses contracts
and prepares recommendations and incorporates legal language within payer
contracts that is consistent with the Company’s legal policy.

 

Oversees the Payor
Credentialing Team for Fairfield Medical Center and Fairfield Healthcare
Providers
.

Performs all duties and responsibilities in accordance to
the established FMC policies, procedures and guidelines.

 

Job
Qualifications

 

Education:  Bachelor’s Degree.  Equivalent Combination of Education and
Experience may be considered.
   

 

Experience:  5 years’ experience with negotiating
Healthcare Managed Care Contracts for Hospital and Physicians.
      Working knowledge of both Managed Care and
Provider Insurance Credentialing required.
 
Working knowledge of government and non-government insurance, payer
requirements, and healthcare operations required.
  Excellent knowledge of healthcare revenue
cycle, healthcare finance, CMS and state regulations and healthcare compliance
requirements/activities required.
 
Experience in Cerner preferred. 

Job-related
Skills:
      
Strong
interpersonal, communication and presentation skills; ability to problem-solve
and facilitate resolution to issues; demonstrates ability to handle multiple
priorities; ability to make independent decisions.

  • Strong knowledge of Revenue Cycle

  • Strong knowledge of commercial payer contracts

  • Strong knowledge of governmental revenue cycle
    compliance

 

Organizational
Expectations and Responsibilities:

 

  1. Mission and Service Values

    1. Empathy 
      Demonstrates a willingness to understand others’ perspectives, without labeling
      or judging; treats others with compassion and is personally engaged in
      providing patient and family-centered care.

    2. IntegrityTakes responsibility for own
      words and actions; has passion and courage to do the right thing; delivers on
      promises and commitments; is honest and achieves excellence in all things
      through ethical and legal behavior.

    3. Stewardship—Uses FMC
      resources wisely; respects the time and resources of patients, family and
      peers; shows pride in FMC and gives back to the Center and community with time,
      talent and /or money.

    4. Agility—Demonstrates
      courage to take initiative to find creative solutions; anticipates concerns and
      responds promptly; minimizes bureaucracy and explores opportunity for growth.

    5. TeamworkWorks collaboratively, not in silos; treats others
      with courtesy and respect; assumes good intent and welcomes differing
      viewpoints; creates a spirit of belonging and fellowship within FMC; embraces
      the FMC culture.

  2. Commitment and Engagement

    1. Quality—Demonstrates
      commitment to improve individual performance and contributes to team
      accomplishments and quality improvement initiatives.

    2. Safety—Creates and
      maintains a safe and clean work environment and reports unsafe conditions to
      the appropriate individuals.

    3. Service—Recognizes and
      anticipates the needs of customers and strives to surpass customer
      expectations; utilizes AIDET, TeamSTEPPS and other tools to avoid and/or
      resolve concerns with the best possible outcome.

    4. Sustainability—Demonstrates
      timely, accurate and cost-conscious use of resources in the daily work.

  3. Personal Engagement

    1. Organization Commitment—Complies
      with FMC policies, procedures, work instructions and guidelines; reports
      compliance or ethical concerns to appropriate personnel; does not gossip but
      works to create a positive work experience with others.

    2. Personal Commitment—Demonstrates
      ownership of the job; willing to step up and help others; works across
      departmental lines; is fully present at work—physically and emotionally; maximizes
      own talents and that of others.

    3. Personal Growth—Demonstrates
      a commitment to ongoing learning; completes all mandatory education and
      participates in learning events/opportunities/experiences to enhance on-the-job
      performance.

 

Essential
Job Functions

 

Job
Expectations and Responsibilities:

  1. Negotiates with healthcare payers
    to ensure that hospital and physician services are reimbursed at a rate that
    covers the costs of the services provided. 

  2. Works with the Revenue Cycle Leadership
    team to identify and negotiate with the payers on any deviations from
    contracted rates or terms. 

  3. Ensures that the organization
    is “in Network” for the vast majority of payers that our customers have.

  4. Ensures that the hospital and
    employed physicians are credentialed with all payers to ensure that the hospital
    is paid for services.  This includes both
    credentialing and re-credentialing with payers as necessary.

  5. Assists the Revenue Cycle Leadership
    team and CFO with other payer issues as directed.

  6. Manages the day-to-day
    operational activities of the department to include:  scheduling; time and attendance record
    keeping, interviewing, hiring, performance management, coaching and
    development, project management, budgeting, work assignment and follow up.

Physical Capacity Demand

 

Medium Work:  Exerting
up to 20-50 pounds of force occasionally, and/or up to 10-25 pounds of force

                        frequently, and/or a
negligible up to 10 pounds amount of force often.

 

Job
Considerations

 

Psychological/Mental – analytical abilities, memory, problem-solving and
creativity

 

                Physiological-
Potential Exposures:  
Electrical equipment

 

Cognitive-Communication
and collaboration with other co-workers, 
physicians, other employees, and patients and families;  prioritizing and time management;  persuasiveness and judgment

 

                Environmental-no special considerations

 

                Protective Equipment- no
special considerations

Reach Out to a Recruiter


  • : taruns@vtechsolution.us