JOB SUMMARY:

Responsible for oversight of the managed care contracts through implementation of systems assuring contract compliance, contract data management, and business development as it relates to health plans/payors. Overall field support will include but it not limited to negotiations, contract interpretations/clarification, case management, education and resources. Understanding claims and intervention when required as the liaison between KabaFusion and health plan/payors. Understanding of current law and regulations and as may be directed by AVP of managed care.

MAJOR DUTIES AND RESPONSIBILITIES:

1. Contract negotiation/renegotiation with health plans, medical groups, IPAs or other managed care payor sources.

2. Ability to establish and maintain professional business relationships with health plans contract managers.

3. Annual rate negotiations

4. Knowledge/Understanding of Division of Financial Responsibility of payors

5. Knowledge/Understanding of varies payor product lines

6. Knowledge of and routine review of contract language

7. Assure Pharmacies remain fully credentialed with all payors to include management of documents required for credentialing process

8. Provide assessment and recommendations for contractual operation of managed care patients

9. Provide training support/resources to the field related to managing/analyzing costs

10. Knowledge of high cost medications /supplies/DME and education/review of pharmacy costs to identify exclusions and guidance to AR on collecting

11. Implement cost reduction measures for the provision of ancillary services of managed care include analysis, recommendations, etc.

12. Assist with creation and implementation of managed care policy and procedures

13. Update/maintain managed care manuals cost analysis and contracts

14. Ensure all contracts meet company standards and are fully executed

15. Other duties as assigned.

SKILLS AND ABILITIES:

• Knowledge of managed care contracting billing and negotiations skills a must
• Strong oral and written communication skills
• Strong problem solving skills
• Exceptional computer skills specially in Microsoft Word, Excel and Outlook
• Strong interpersonal skills to interface effectively with all levels of personnel
• Ability to maintain confidential company information
• Attention to detail
• Ability to self-direct work and effectively multi-task

EDUCATION AND/OR EXPERIENCE:

• Must possess at a minimum, Bachelor's degree in Business or related experience
• Minimum of 7 years of experience in health care industry, infusion experience a plus
• At least 3 years managed care contracting, billing and negotiations skills required

What we offer:

• Competitive compensation
• Benefits start on your 1st day of employment
• 401k w 4% match - no waiting or vesting period
• PTO / Floating Holidays / Paid Holidays
• Company paid life insurance, short term disability
• Employee Assistance programs to help with mental health / wellness
• Learning & Development Programs
• Perks... includes discounts on travel, cell phone, clothing and more...
• Generous employee referral program