Position DescriptionOversee the execution and development of all external managed care contracts (MCCs) and contractual relationships
critical to the financial health of TTUHSC El Paso and it's referral base. Additionally, this position will plan, direct and
oversee all daily operations within the office of provider services (credentialing and enrollment).
Major/Essential Functions- Serve as institutional leader and partner to optimize managed care contractual terms and provisions, and provider credentialing, while operating with significant autonomy in maintaining and increasing the contracted business and negotiating rates enabling TTUHSC El Paso to meet its financial objectives through ongoing and comprehensive analysis in the evaluation of existing structures and rates.
- Initiate, develop, negotiate, and monitor contracts on behalf of TTUHSC El Paso.
- Negotiate with external parties with differing financial objectives (from TTUHSC El Paso). Work to solidify contracts to include TTUHSC El Paso within their provider network(s) while agreeing to pay rates which meet TTUHSC El Paso's financial needs. Includes contractual language and terms of payment rate and structure.
- Address a wide, complex spectrum of critical management issues, while developing new partnerships and reimbursement methods for retention.
- Oversee all systems used to calculate expected payment and generate contractual allowances for contracted and noncontracted payers for PLFSOM (Paul L. Foster School of Medicine) net revenues. Collaborate with fiscal, revenue cycle and information systems areas to address and resolve system problems, maintenance, and improvements.
- Respond effectively to new health insurance entities and products entering the market.
- Develop and implement contract strategy. Initiate and retain contracts with health plans that are strategically important to the TTUHSC El Paso. Lead complex negotiations and manage ongoing relationships with these health plans and groups.
- Investigate potential and existing contract providers to identify opportunities for increased referrals to TTUHSC El Paso.
- Project contract performance based on modeling of actual and representative samples. Monitor contract performance and other provisions to assure compliance, identify problem areas, and resolve disputes. Oversee the development and maintenance of the revenue modeling modules.
- Develop and implement strategies essential for meeting NCQA, state of Texas and CMS requirements and compliance.
- Serve as a liaison and representative of TTUHSC El Paso pertaining to the initiation, development, negotiation, and monitoring of MCCs. Negotiate and build relationships directly with executives, senior leaders, administrators, and attorneys from external entities.
- Function as claims project resolution manager. Collaborate with billing supervisors and staff to resolve issues, and ensure compliance, related to contractual and billing requirements.
- Lead managed care business development groups for projects related to the development of strategic presentations designed for payers. Provide oversight and analysis of MCC services and evaluations of program offerings, health trends and pricing strategies.
- Adhere to all TTUHSCEP policies, procedures and processes.
- Personally demonstrate, display and act in accordance with TTUHSC EP's Values (Service, Respect, Accountability, Integrity, Advancement, and Teamwork). Serve as a Value's leader while actively promoting and encouraging staff across the institution.
- Remains current with all licensure, certifications and mandatory compliances and trainings required of this position.
- Perform all other duties as assigned.
Preferred Qualifications- Three years of experience in a managed care plan/office.
- Strong analytical skills with the ability to assess compliance, record, analyze, and interpret data into meaningful formats.
- Demonstrated ability to effectively communicate (orally and written) while also displaying excellency. interpersonal skills.
- Demonstrated understanding of managed care contract analysis, negotiations and strategic alignment specific to a health sciences center.
Pay StatementCompensation is commensurate upon the qualifications of the individual selected and budgetary guidelines of the hiring department, as well as, the institutional pay plan. For additional information, please reference the institutional pay plan on the Human Resources webpage.
Required Qualifications- Bachelor's degree in a related area plus five years of progressively responsible management experience OR a combination of education and/or years of experience in management to equal a minimum of 9 years.
