Job description
Payer Relation & Contracting Manager
Summary:
As a
Payer Relations & Contracting Manager, you will have the opportunity to manage the negotiation and review of payer and contracts for the organization. Responsible for implementing, operationalizing and administration of third party payor/Managed Care agreements. Assist and support relationships with Health Plans and third-party payors. Coordinate and facilitate education of hospitals, physicians and staff relative to the operational, payment, quality programs and initiatives specific to each third-party payor, Conducts contract modeling and analysis with an understanding of population health and value-based contracting. Provides expert advice, analytic and consultative support. Leads large scale initiatives with high dollar cost savings opportunities. Partners with provider contractors to develop contracting strategy and supports all aspects of the contract negotiation process.
Responsibilities:
- Negotiate with managed care organizations and/or insurers to obtain provider service agreements that advance the profitable revenue growth. Some major agreements may be negotiated in conjunction with the executive management team.
- Support the development and contracting for value-based population health opportunities and new reimbursement models.
- Manage financial modeling specific to contracting efforts, ensuring negotiated rates meet desired objectives.
- Provide reports and analysis of performance, providing recommendations and feedback for contract renewals, renegotiations or termination
- Serve as a relationship manager with payers in the market.
- Monitor all aspects of the relationship to ensure appropriate communication and contract compliance and maintaining delegated payer credentialing status.
- Solid understanding of managed care, payment approaches, risk and capitation and managed care knowledge and experience negotiating fee for service managed care contracts.
- Excellent negotiation and partnering skills.
- Responsible for delivering critical information concerning covered services, participating and non-participating providers, carve-outs and fee schedules to affected internal clients in a timely manner; facilitate clear and unequivocal communications between contractors and health system clientele as necessary to ensure smooth implementation of agreements and continued payment compliance.
- Oversea credentialing and payer enrollment operations.
Requirements:
- Bachelor’s Degree in business, health care or related field.
- Experience in a Managed Care organization, Health Plan, PHO, PO and ACO or similar organization.
- Experience with standard and innovative contract and reimbursement methodologies, including but not limited to fee for service, value-based payments, risk contracting, capitation and bundled payments.
- Seven+ (7) years’ experience in provider contracting and servicing within a complex environment of physician groups or multi-specialty groups with value-based arrangements preferred
- Established relationships with Health Plans, other Industry Professionals.
Why work for EPIC Health?
We offer a competitive compensation and benefits package including:
- Bi-Weekly Competitive Pay
- Opportunities for professional and personal growth
- Excellent Health Insurance through Blue Care Network with a VIP policy to provide you with affordable access to the best care
- Premium Dental and Vision coverage
- Buy Up Option for Short- and Long-Term Disability, and Life & AD&D Insurance
- 401(k) investment opportunities
- Generous Holiday, Vacation and Personal time
- Work/Life Balance
- Employee Recognition and Assistance Programs
About the fam:
EPIC Health System was founded in 2000 in Ferndale, Michigan by two bright physicians, Drs. Ted and Greg Naman – who also happen to be brothers. Over the last 20+ years, EPIC Health has evolved to stay on the cutting edge of integrated and comprehensive care by using techniques from within healthcare and other industries to drive growth and innovation. Even with all this growth, our constant commitment to providing the highest quality of care to our communities has helped us completely transform the way healthcare is delivered – and we’re not done yet!
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