Payor Contracts Manager - RT

  •  

Vancouver, WA

Industry: Misc. Healthcare

  •  

5 - 7 years

Posted 336 days ago

  by    Kevin Meyers

Payor Contracts Manager - RT

Vancouver, Washington 98663

JOB SUMMARY

Responsible for the analysis, negotiation, monitoring and administrative oversight for a wide variety of complex third party payor contracts. Provides ongoing maintenance of contracts to ensure compliance.  

ESSENTIAL FUNCTIONS

  1. Negotiates financial terms and responsibilitieswith third party payors, including employers, preferred provider organizations, accountable care-type organizations and traditional health insurers. Skilled in handling potentially adversarial situations requiring resolution.
  2. Reviews contractlanguage, establishes standard contractlanguage, and negotiates contractlanguage issues with third party payors.
  3. Proactively looks for new opportunities to improve the development of new contracts and with existing contracted entities, for the benefit of PeaceHealth. 
  4. Prepares reports, contributes or manages contracting website, prepares contract summaries, PowerPoint presentations, and correspondence as requested by the PeaceHealth leadership to support the contracting process.
  5. Manages a variety of relationships with external contacts, PeaceHealth leadership, and various internal departments for the key purpose of resolving and/or preventing compliance issues and disputes.   
  6. Responsible for maintenance of contract files and continuous improvement of the contract renewal cycle in order to meet the financial and operational efficiency goals of PeaceHealth.
  7. Responsible for annual review of contract performance and payment terms, initiating revisions as necessary to continually improve payor contract performance.
  8. Complete facility credentialing and re-credentialing documents on a routine basis as required by the health plans, keeping up to date on facility licensing, accreditation, insurance and services offered at each hospital.
  9. Evaluates operational performance of payors and the impact on staff and the organization for the purpose of improving payor performance and reducing operational inefficiencies involved in healthcare administration processes.
  10. Performs other duties as assigned. 

Required Knowledge, Skills, and Abilities: (Submission Summary)

1. BA degree in Healthcare or Business required or a combination of education and experience that provides the caregiver with the requisite knowledge, skills and abilities to perform the job. 

2. A Master’s degree in Supply Chain Management, MBA or MSN is preferred.

3. Five years progressive experience in an applicable area of the healthcare industry such as business development, legal contract department, provider relations, patient financial services, financial analysis. 

4. Prefer direct experience in contract negotiations and analysis for a third party payor or healthcare delivery system.

5. Knowledge of traditional fee-for-service contracts and reimbursement methodologies for both hospital and professional services. 

6. Computer experience and working knowledge of MS Word and Excel required. Knowledge of Access, PowerPoint, DataMart, and ProClarity desired. 

7. Strong analytical, organizational and problem-solving skills.

8. Proven ability to conceptualize issues and develop pragmatic solutions.

9. Demonstrated ability to work independently and able to manage and prioritize large projects while focusing on details.

10. Knowledge of standard health insurer policies, benefit design, ICD-10, CPT, DRG coding requirements, case rates, DRG-based payment, as well as population focused contracts (pmpm, risk pools and funding approaches, financial and clinical services quality incentives, bundled payments, etc..

11. Knowledge and understanding of private and public healthcare financing, reimbursement protocol and government regulations related to healthcare services.

12. Excellent verbal and written communication skills. Must be able to articulate complex business issues.

13. Must be able to retrieve computer data, receive and process a large quantity of detailed, complex verbal and written information quickly.

14. Present Salary?

15. Salary Expectation?

16. Must be a US Citizen or Green Card holder?

17. Current Address?