ESSENTIAL DUTIES AND RESPONSIBILITIES:
1.Contract Negotiation: Collaborate with healthcare providers and insurance companies to negotiate contract terms, reimbursement rates, and other key aspects of the agreement. Involves reviewing and analyzing contractual language, identifying areas for negotiation, and working towards a favorable outcome for all parties involved.
2. Provider Network Development: Identify and recruit healthcare payors to have Always Compassionate Health become a network provider to include all available services under its portfolio from personal care services to home infusion clinical services.
3. Contract Administration: Oversee the implementation, recredentialing and maintenance of contracted agreements. One must ensure compliance with contractual terms and conditions, monitor provider performance and adherence to quality standards, and address any issues or disputes that arise during the contract period.
4. Financial Analysis: Analyze and evaluate financial data related to managed care contracts, including fee reimbursements, reimbursement methodologies, and utilization patterns. Identify opportunities for revenue enhancement, process improvements, and make recommendations based on the analysis.
5. Relationship Management: Foster positive relationships with healthcare payers and government entities. Serve as the main point of contact for inquiries, concerns, and dispute resolution. Collaborate with internal departments to address provider-related issues and ensure smooth operations.
6. Regulatory Compliance: Stay up to date with applicable laws, regulations, and industry trends related to contracting. Ensure compliance with state and federal regulations, accreditation standards, and contractual obligations.
7. Performance Monitoring and Reporting: Develop and implement performance metrics and reporting mechanisms to evaluate the effectiveness of payer contracts.
Qualifications/Education:
• Bachelor's degree in healthcare administration, business, or a related field (Master's degree preferred)
• Knowledge of managed care principles, reimbursement methodologies, and healthcare delivery systems
• Strong negotiation and contract management skills
• Analytical and financial acumen for evaluating data and financial implications.
• Excellent communication and interpersonal skills for building relationships and resolving conflicts.
• Familiarity with homecare/ healthcare regulations and compliance requirements
Requirements:
• Ability to handle multiple tasks.
• Ability to problem solve.
• Computer literate in fiscal management and other database programs.
• Demonstrate trustworthiness and discrete disposition in carrying out regulatory tasks.
• Excellent written and oral communication skills.
• Possess excellent interpersonal skills and ability to work well with others.
Work Environment:
• Ergonomic workspace
• Ambient interiors
• Organized office plan
• Hygienic environment
• Employee satisfaction
• Staff loyalty
• Employee empowerment
• Career growth
