Coordinates the managed care contracting process. Develops managed care rates and monitors contract activity. Maintains an effective role as liaison with health plans.
Builds and maintains close third-party payer relationships through appropriate and timely written and phone communication.
Supports in the summary and distribution of policy changes and managed care communications.
Ensures all public information regarding CentraState's network participation information is correct and current, responds to inquiries regarding plan participation.
Assists in the identification and resolution of managed care operational issues such as contract compliance, denials, authorization for services, billing, and claims payment.
Supports in negotiations of managed care agreements for the Medical Center, Family Medicine Center, and Senior entities with potential activities including, but not limited to, precursory language reviews, modelling rate proposals, preparing P/L reports, and surveying organizational impacts.
Provides analytical support for alternative payment models such as bundled payments, shared savings and value-based negotiations with varying degrees of risk.
Maintains managed care contracts, a rate matrix, managed care statistics and educational information databases.
Ensures all credentialing and related support documents are current and assists in completing new credentialing applications, where necessary.
Conducts analyses and variance reviews to ensure reimbursement compliance and supports in the pursuit of revenue recovery.
Serves as an organizational liaison between managed care organizations and the medical center, physician organizations, patient financial services, access, and senior entities.
Bachelors Degree in Finance or related field required.
3 years of Financial Experience in a Healthcare Facility required.
Organized, motivated and reliable self-starter with strong analytical and communication skills as well as an acute attention to detail with the ability to prioritize tasks and rely on experience and judgment to plan and accomplish goals within time constraints.
Knowledge in reimbursement and/or contract negotiation activities required. Maintains working knowledge of State and Federal regulations as they apply to providers, managed care contracts, and third party payors.
Strong professional, organizational, and interpersonal skills to effectively relate with all members of the healthcare team.
Kneeling/Stooping Never Bending/Climbing Never
Reaching Above Shoulder, At Waist or Below Waist Never
Lifting/Pushing or Pulling up to 40 pounds Never
Lifting/Pushing or Pulling over 40 pounds Never
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Centrastate Healthcare System