Contract Manager - Managed Care

Wellstar Health System, Inc. Marietta , GA 30060

Posted 2 weeks ago

Overview

At WellStar we all share common goals. That's what makes us so successful and such an integral part of our communities.

We want the same things, for our organization, for our patients, and for our colleagues. As the most integrated healthcare provider in Georgia, this means we pride ourselves on investing in the communities that we serve. We continue to provide innovative care models, focused on improving quality and access to healthcare.

Responsibilities

Contract Manager is accountable for negotiating; developing and analyzing Hospital/Physician activities across the

enterprise. The Contract Manager will be responsible for managing the facilitation and implementation of each

Managed Care agreement through internal and external operational reviews. Maintains and updates the Executive

Director on legal and regulatory trends with respect to managed care and the enterprise. Negotiations will typically

include both financial and contractual terms. Position will assist in resolving billing or other contractual problems with

insurance carriers on behalf of the providers. Facilitates resolution of contractual and operational issues with

insurance carriers in order to enhance the managed care contract performance. Contract Manager will assist and

work collaboratively with other contract managers in inclusive contract negotiations with insurance carriers.

KEY RESPONSIBILITIES:

Manages the day-to-day Managed Care operations and contracting activities.

Negotiates successful contracts with Managed Care organizations.

Analyzes financial component of contracts using internal software system.

Networks with payers, providers, and others throughout the region in order to build and maintain market

knowledge and market direction.

Perform periodic and specific reviews of volume and pricing in an effort to maximize contract performance and

continuous improvement.

Contacts Managed Care organizations to resolve discrepancies between contracts and payments.

Coordinates, facilitates, or assists scheduling JOC meetings between the hospital and Managed Care

organization to discuss/resolve contractual and operational issues in order to enhance managed care contract

performance.

Assist in resolving billing or other contractual problems with payors on behalf of the providers through Provider

Relations Department.

Reviews all Payors , Monthly, Quarterly or when or how ever posted either via secured payor web portals,

payors inter-net sites or any means made available from payor for updates in Policies and Procedures or any

changes a Payor would make that may change a WellStar course of business.

Determines if change to P & P will have financial adverse impact to WellStar if so communicates with internal

and external parties WellStar's objection via written communication to payor.

Monitors and updates the Executive Director on political, legal and regulatory trends with respect to managed

care and vertical integration.

Assist the WellStar acquisition and/or service growth (i.e. facilities, physicians, services, etc.) related organizational activities in order to successful transition/implement all managed care needs.

Qualifications

Required Minimum Education: A bachelor's degree from a recognized college in healthcare, business, finance, or related field required.

Required Minimum Experience: Five years' experience in Managed Care contract negotiations or related activities.

Required Minimum Skills:
Ability to build relationships with outside vendors.

Ability to build strong relationships with internal customers and departments. Strong verbal and written communication skills. Ability to negotiate. Attention to detail and the ability to independently problem solve.

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Contract Manager - Managed Care

Wellstar Health System, Inc.