MANAGED CARE CONTRACT SPECIALIST in Tampa, Florida at H. Lee Moffitt Cancer Center

Managed Care Contract Specialist

Position Highlights:

The Managed Care Contract Specialist is responsible for negotiation, maintenance, issue resolution and internal coordination of assigned managed care contracts and proposals for Moffitt Cancer Center and Moffitt Medical Group under the guidance of the Director of Managed Care. The Managed Care Contract Specialist performs contract language review and negotiates language and rates with payers to maximize reimbursement, reduce exposure, and streamline administration. This position will manage payer relationships, gather and analyze data for managed care contract negotiations, communicate contract terms and conditions to appropriate internal parties, maintain contract specific reference materials, research and resolve managed care related issues, and collaborate with internal team members on the analysis of contract performance and compliance.

Responsibilities:

• Develops, negotiates, administers, and maintains managed care agreements, including but not limited to, physician, hospital, and delegated credentialing agreements together with letters of agreement consistent with Moffitt guidelines and under the direction of the Director of Managed Care. Negotiations include contractual language and reimbursement rates and will include support to Managed Care Contract Manager major negotiations and independent negotiations with secondary payers.
• Works with internal team members to help validate financial models needed to assess reimbursement opportunities presented during contract negotiations.
• Develops and maintains relationships with internal matrix partners and external payer partners.
• Analyzes the managed care environment; monitors and communicates trends in national, regional, and local markets.
• Understands Moffitt's value proposition and articulates the same with payers.
• Evaluates possible reimbursement methodologies and business initiatives in view of their relevance and marketability to payers.
• Responsible for contributing to the researching, tracking, trending, and resolving of payer issues
• Works with the Revenue Cycle Departments and internal teams to resolve systemic payer issues
• Serve as the contact person for enforcing the terms of assigned managed care contracts.
• Partners with Managed Care team to serve as an organization wide resource for managed care related issues.
• Takes ownership and/or coordinates with appropriate Moffitt team members and managed care plan contacts to ensure prompt resolution of issues identified.
• Follows up with payers as necessary for status
• Manage matrices, tables, documents, and other ongoing contract management tools.
• Provides appropriate physician and staff education to support the managed care activities of Moffitt.
• Analyzes and monitors the financial impact of new and existing managed care agreements under the direction of the Director of Managed Care.
• Identifies opportunities to gain efficiencies and greater effectiveness in contracts.
• Managed and/or support process improvement related to managed care contract administration.
• Assists various Moffitt Departments with resolving patient access issues related to patient insurance.
• Provides support to individual patient Letters of Agreement with non-contracted payers as needed.
• Conducts research, prepares analysis, and makes recommendations to management related to managed care initiatives.
• Completes special projects as assigned in a timely and consistent manner.

Education and Credentials:

• Bachelor’s Degree – field of study: Healthcare, Finance or related field.
• Minimum three (3) years experience in contract administration, procurement, or healthcare, communications, or operations management.

Preferred:

• Direct experience negotiating managed care contract language and rates.