The VP of Managed Care Contracting is responsible for direct revenue contract management including negotiation, analysis interpretation, implementation, maintenance of the contracts performance, and payer relations. The position is also responsible for coordination and communication between managed care and other key stakeholder departments and Leadership. Responsible for developing new and existing relationships with third party payers to ensure competitive reimbursement rates and contract language attainable through the revenue cycle operations for the evaluation, negotiation, and implementation of payer contracts to ensure best possible hospital and physician reimbursement methodologies. Models appropriate behavior as exemplified in MLH Mission, Vision and Values.
Bachelors Degree in Business, Finance, Accounting, Healthcare Administration, other related field required.
Minimum five years experience working in a health care contracting role between third party payors and healthcare providers
Master’s degree preferred.
- Strong technical knowledge of managed care contracting, payer policies, hospital and physician reimbursement methodologies, and state and regulatory requirements.
- Track record of successful negotiations between major payor organizations and healthcare providers.
- Strong organizational and interpersonal skills, with ability to communicate effectively, both orally and in writing.
- Ability to communicate effectively with all levels of Associates, management and senior leaders, including the ability to communicate complex technical material.
- Ability to lead and motivate individuals and groups of people toward the accomplishment of work and organizational goals.
- Excellent organizational and analytical skills.
Key Job Responsibilities
- Development of new and existing relationships with third party payers to ensure competitive reimbursement rates and contract language attainable through the revenue cycle operations.
- Evaluate, negotiate, and secure financially and administravely favorable managed care contracts with new and existing health plans/managed care organizations. Develop and support managed care strategies and initiatives for MLH to adapt to ongoing healthcare payment reforms and evolving payment methodologies.
- Define contract negotiation objectives in coordination with the Executive and Senior Leadership team and manage and support the maintenance of a detailed utilization database.
- Monitor and plan for contract renewals, budget increases, and ensure that all renewals are completed. Works with the CFO’s for budgeting increases annually.
- Serves as a resource for information about contract terms, managed care projects, payer processes, revenue cycle inquiries, and to facilitate the resolution of complex issues that arise.
- Responsible for communications with third party payers regarding updates to the health system including changes in locations, additions, or other material system changes that impact payer contracts and reimbursement.
- Coordinate preparation and completion of due diligence process for new entity acquisitions. Prepare documents for payers reporting changes in facilities or physician group information.
- Manage all components of the contract negotiation process for directly negotiated contracts. Assist JV partners with payer negotiations on behalf of JV facilities and physician entities.
- Identify and implement contracting opportunities for revenue improvement and administrative efficiency, and ensure that contract renewals are modeled for financial impact.
- Identify opportunities with payers to acquire premier provider designations for hospital entities and physicians. Seek opportunities for new patient volumes through payer initiatives.
- Participate in activities which result in improved contract performance, which include performing payer analysis and communicating with all Revenue Cycle teams.
- Participate and/or facilitate regular meetings with third-party payers to ensure continuing contract performance, identify payer issues affecting payment or operations, discuss/ resolve claim issues resulting from contract interpretation and/or language, and to assist hospital staff in developing relationships with payers.
- The physical activities of this position may include climbing, pushing, standing, hearing, walking, reaching, grasping, kneeling, stooping, and repetitive motion.
- Must have good balance and coordination.
- The physical requirements of this position are: light work - exerting up to 25 lbs. of force occasionally and/or up to 10 lbs. of force frequently.
- The Associate is required to have close visual acuity to perform an activity, such as preparing and analyzing data and figures; transcribing; viewing a computer terminal; or extensive reading.
- The conditions to which the Associate will be subject in this position: The Associate is not substantially exposed to adverse environmental conditions; job functions are typically performed under conditions such as those found in general office or administrative work.