Randstad Senior Managed Care Contractor in Southfield, Michigan
Senior Managed Care Contractor
Friday, September 30, 2016
Randstad Finance & Accounting
The Senior Managed Care Contractor is responsible for managing the day-to-day activities of healthcare payer contracts and employer population health management (PHM) contracts in collaboration with the Vice President of Finance and Contracting. The Senior Managed Care Contractor will handle the implementation and execution of new payer or PHM contracts and administration of existing contracts. The Senior Managed Care Contractor will also support the Vice President of Finance and Contracting with payer and employer negotiations.
Roles and Responsibilities
Manages day-to-day operations of payer and population health management (PHM) contracts. This may include implementation of contracts, issue resolution for Clinically Integrated Networks (CINs), annual settlement process, identification of contract non-compliance and contract renegotiations.
Supports the Vice President of Contracting and Finance to develop payer strategies to facilitate member growth in value-based reimbursement contracts. This will include development of business plans and obtaining CIN and sponsor support of business plans.
Facilitates legal review and approval of payer and PHM contracts.
Educates and supports staff with payer and PHM contracts.
In collaboration with the Vice President of Network Development, educates and engages CINs in payer and PHM contracts.
In collaboration with the Medical Director and payers, develops and administers Clinical Incentive Programs for payer contracts.
Collaborates with and provides support to other employees of Company as needed.
Conducts special projects as requested by the Vice President of Finance and Contracting.
All other duties as assigned.
Reports to and supports the Vice President of Finance and Contracting.
Bachelor s degree in business, healthcare management, accounting, finance, or related field.
Five (5) to seven (7) years of related experience in a hospital, health system, managed care plan, Accountable Care Organization, physician organization or related entity.
Three (3) to five (5) years of contracting experience and negotiations within a hospital, health system, managed care plan, Accountable Care Organization.
Comprehensive knowledge of industry standard managed care contract terms.
Knowledge of healthcare contracting and reimbursement mechanisms and terms, including, but not limited to DRGs, APCs, tiered payment rates, bundled payments, discount from charges, fee-for-service, capitation and per member per month.
Experience with pay-for-performance programs and knowledge of standard measures and ability to calculate results and payment distribution across partner physician organizations.
Ability to work independently with minimal supervision of daily tasks.
Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex information in a manner that others can understand, as well as ability to understand and interpret complex information from others.
Intermediate conceptual analytical and quantitative skills.
Advanced proficiency with information/financial management systems and other personal computer software applications such as Microsoft Office.
Comfort with working in a self-driven, start-up environment.
Interest in and active pursuit of opportunities to learn and grow, and ability to handle multiple demands, shifting priorities, crises, and rapid change
Managed care contracting analysis and support.
Master s degree in Business Administration, Accounting or Finance.