1) Develops strategy for evaluating potential impacts of reimbursement changes on overall financial position and establishing return on investment under value-based payment programs.Â Â
2) Assists the various provider types including hospitals, physicians and ancillary providers in implementation of contracted proposals and supports providers in on-going efforts to improve contractual performance under managed care agreements.
3) Evaluates and recommends financial parameters and reimbursement methodologies.
4) Analyzes and monitors financial aspects of existing managed care contracts. Utilize analysis for feedback on contract renewals, renegotiations or termination. Make recommendations regarding participation or non-participation with new or existing agreements. Provide feedback to Revenue Cycle & Managed Care Committees regarding financial and/or operational issues with payors.
5) Establishes and maintains executive level oversight and relationships with contracted payors for the Faculty Practice.
6) Maintains and distributes participation information by payor by network product for all signed contracts, contracts under-negotiation, or plans.
7) Supports strategic planning accountability for other reimbursement & profitability endeavors with subcontract arrangements, government programs, pay for performance and overall value-based care initiatives.
8) Partners with financial and clinical leadership on the development of compensation plans which align with the requirements of value-based care programs/contracts and initiatives. Represent the Faculty Practice interests within the CIN.
9) Liaison and collaboration with all clinical departments and all administrative departments on managed care issues.
10) Assembles information and prepares materials for presentation to committees, faculty members, administrators and managed care networks.
11) Demonstrates ability to establish two-way communication by clearly defining expectations, communicating through a variety of methods, actively listening to ideas and concerns and responding in an appropriate manner, complete responsibilities appropriately and timely, retain composure under stress.
1) Good knowledge of contractual, administrative, health insurance and operational issues related to managed care organizations, physician groups and hospitals
2) Demonstrated knowledge of managed care and value-based principles and experience with risk-based contracting structures and contract language
3) Excellent analytical and problem-solving skills.
4) Knowledge of health insurance benefit plan designs
5) Ability to engage directly and effectively with people at all levels of the organization
6) Excellent communication stills, both verbal and written
1) Master's degree or above
1) 10 years of experience in health care or managed care industry
Required Documents 1) Resume
NOTE: When applying, all required documents MUST be uploaded under the Resume/CV section of the application
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