Managed Care Contract Specialist
Managed Care Contract Specialist
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Job Description
Must Have
Hospital Contract Modeling
Third Party Payer Negotiation
Literacy with health insurance plans
Payment Integrity Compass or EPIC experience
Job Description
Responsible for building loading testing and maintaining hospital thirdparty payer contracts in the contract modeling system. Accountable for analyzing relevant data and translating into reporting to support necessary determinations of adjustment to ensure maximization of values for contract negotiation purposes and ultimately final agreed reimbursement meeting System financial and operational expectations. Participates in active thirdparty payer negotiation discussions representing modeling work product through necessary iterations of rate modeling and analysis.
MINIMUM QUALIFICATIONS
Education: Bachelors degree in Business Administration Finance or Accounting preferred.
Licenses/Certifications: Required to complete training and become certified in the applicable EPIC applications within the first 90 days of employment to include Resolute Hospital Billing Expected Reimbursement Contracts Administration.
Experience / Knowledge / Skills:
- Three (3) years experience in hospital contract modeling required (preferably in Payment Integrity Compass (PIC) or Epic).
- Effective oral and written communication skills.
- Ability to analyze problem solve and apply critical thinking in a fastpaced environment.
- Strong organizational skills with the competency to work independently as well as part of a team and prioritize responsibilities.
- Must possess proficient Excel skills (i.e. pivots vlookup functions).
PRINCIPAL ACCOUNTABILITIES
- Accurately loads tests and maintains executed hospital contracts in the contract modeling system which subsequently flows into System financial adjustments netting accounts receivable at time of billing.
- Performs prospective modeling of proposed contracts rate structure/value scenarios and other changes impacting reimbursement to support payer negotiations in addition to daily operations.
- Analyzes and determines the financial impact of government (federal and state) and commercial fee schedule/reimbursement changes to develop proposed adjustments (what if scenarios) to support negotiations.
- Loads and maintains hospital contract reimbursement and terms in an internal database for applicable user and vendor accessibility.
- Generates standard and adhoc reporting allowing for critical decisionmaking specific to hospital reimbursement and associated impacts.
- Supports Managed Care Contract Administrators with identification of opportunities risks errors etc. in payer reimbursement proposals and counterproposals for comprehensive value review and accuracy.
- Serves as a Subject Matter Expert (SME) in conjunction with the Managed Care Contract Administrator relevant to facility and/or professional contract reimbursement.
- Collaborates with the Revenue Cycle Finance Government Reporting and various other internal stakeholder departments to address contract variances discrepancies and contributes as appropriate in other thirdparty payer contract reimbursement related projects.
- Works collaboratively with external System vendors regarding contract audit activities and various thirdparty payer reimbursement related matters.
- Identifies potential process improvement opportunities initiating projects to improve internal operations.
- Ensures safe care to patients staff and visitors; adheres to all Memorial Hermann System policies procedures and standards within budgetary specifications including time management supply management productivity and quality of service.
- Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports departmentbased goals which contribute to the success of the organization; serves as preceptor mentor and resource to less experienced staff.
- Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermanns service standards by providing safe caring personalized and efficient experiences to patients and our workforce.
- Other duties as assigned.
Remote Work :
No
Employment Type
Full Time
