Job Title: Payer Contracting Manager
Reports to: CFO
FLSA Status: Salaried/Exempt
OSHA Exposure Level:
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:
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
Performs all duties and responsibilities in accordance to
the established FMC policies, procedures and guidelines.
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
Experience in Cerner preferred.
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
Expectations and Responsibilities:
Mission and Service Values
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.
Integrity—Takes 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.
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.
courage to take initiative to find creative solutions; anticipates concerns and
responds promptly; minimizes bureaucracy and explores opportunity for growth.
Teamwork—Works 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.
Commitment and Engagement
commitment to improve individual performance and contributes to team
accomplishments and quality improvement initiatives.
maintains a safe and clean work environment and reports unsafe conditions to
the appropriate individuals.
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.
timely, accurate and cost-conscious use of resources in the daily work.
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.
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.
a commitment to ongoing learning; completes all mandatory education and
participates in learning events/opportunities/experiences to enhance on-the-job
Expectations and Responsibilities:
Negotiates with healthcare payers
to ensure that hospital and physician services are reimbursed at a rate that
covers the costs of the services provided.
Works with the Revenue Cycle Leadership
team to identify and negotiate with the payers on any deviations from
contracted rates or terms.
Ensures that the organization
is “in Network” for the vast majority of payers that our customers have.
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.
Assists the Revenue Cycle Leadership
team and CFO with other payer issues as directed.
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.
Psychological/Mental – analytical abilities, memory, problem-solving and
Potential Exposures: Electrical equipment
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