Contract Manager - FT - Days - Managed Care Contracting @ MV

El Camino Health is committed to hiring, retaining and growing the best and brightest professionals who will carry our mission and vision forward. We are proud of our reputation in the community: One built on compassion, innovation, collaboration and delivering high-quality care. Come join the team that makes this happen.

Applicants MUST apply for position(s) by submitting a separate application for each individual job posting number they are interested in being considered for.

FTE

1

Scheduled Bi-Weekly Hours

80

Work Shift

Day: 8 hours

Job Description

Job Responsibilities:

• Negotiates and manages specialty services agreements (i.e. behavioral health agreements, cash pay agreements, medical group agreements), including analyzing financial data, including costs, volumes, types of services and current expected reimbursement and the financial impact of these specialty service agreements.

• Works with internal departments and service line leaders on any issues related to specialty service agreements

• Single Case Agreements - research data necessary for various single case agreements; prepare document for signature; update all involved parties.

• Manage Center of Excellence applications/renewal process- track data requirement submission by various departments in hospital; ensure timely submission of data.

• Manage insurance code assignment process for new codes and/or codes to delete.

• Effectively track and monitor outstanding issues and communicate proactively with stakeholders.

• Maintain contract grid of terms and conditions from the various health plan contracts to serve as job aids for Revenue Cycle team.

• Participate in quarterly/monthly joint operations committee meetings with the health plans.

• As applicable, review of Health plan provider manual and policy updates, review new health plan policies for applicability; distribute to impacted departments for input; track responses; submit policy disputes within required 45 day response time.

Qualifications

• Bachelor's Degree required.

• Minimum six (6) years experience in the managed care field representing hospitals, physicians or payers in contracting functions.

• Ability to review and understand managed care contracts

• Highly collaborative and able to work cohesively in a dynamic team environment.

• Good communicator, skilled in negotiations, able to develop and sustain relationships with health plans

License/Certification/Registration Requirements

N/A

Salary Range:

$61.80 - $92.70 USD Hourly

The Physical Requirements and Working Conditions of this job are available. El Camino Health will provide reasonable accommodations to qualified individuals with a disability if that will allow them to perform the essential functions of a job unless doing so creates an undue hardship for the hospital, or causes a direct threat to these individuals or others in the workplace which cannot be eliminated by reasonable accommodation.

Sedentary Work - Duties performed mostly while sitting; walking and standing at times. Occasionally lift or carry up to 10 lbs. Uses hands and fingers. - (Physical Requirements-United States of America)

An Equal Opportunity Employer:

El Camino Health seeks and values a diverse workforce. The organization is an equal opportunity employer and makes employment decisions on the basis of qualifications and competencies. El Camino Health prohibits discrimination in employment based on race, ancestry, national origin, color, sex, sexual orientation, gender identity, religion, disability, marital status, age, medical condition or any other status protected by law. In addition to state and federal law, El Camino Health also follows all applicable fair and equitable employment policies from the County of Santa Clara.