SR Managed Care Contract Spec in Granger, Indiana at Beacon Health System

Reports to the Manager of Managed Care. Responsible for assisting the Manager of Managed Care in negotiating, maintenance, problem resolution and internal coordination of assigned managed care contracts and proposals for Beacon Health System. Works with the Manager of Managed Care to Manage the contract process for Beacon Health System and is a lead for the department. Acts as a service representative for internal clients and payors, scheduling in-services as needed and works to operationalize the managed care agreements. Responsible for maintaining contracting files and contracting system(s). Supports the management team by providing input into the strategic planning process. Responsible to assist with Beacon ACO and CHA ACO, LLC networks and CMS MSSP as directed.

• MISSION: We deliver outstanding care, inspire health, and connect with heart.
• VALUES: Trust. Respect. Integrity. Compassion.
• SERVICE GOALS: Personally connect. Keep everyone informed. Be on their team.

Maintains coordination for Managed Care contracts with involved entities and is responsible for customer service representation to all clients by:

• Notifying appropriate entities of all new contracts and any alterations of current contracts.
• Developing and circulating all quarterly reports.
• Working on the development of managed care contracts and proposed protocols with the assistance of management.
• Handling contract negotiation/renewal processes and/or undertaking these tasks as directed and/or necessary with the assistance of management.
• Completing administration and enrollment paperwork of new payors and manages maintenance and accuracy of contract management system(s) utilized by the department.
• Serving as a liaison with attorney regarding contract language.
• Attend all applicable meetings necessary to obtain approval on proposed agreements by Beacon Entities.

Supports the management team by:

• Maintaining current contracts, credentialing information and roster of clients.
• Notifying appropriate entities of new payor groups.
• Coordinating activities and resolving problems of key internal functions such as Accounting, Billing, Collections and Registration.
• Assisting management with new product design.
• Assisting in the development and maintenance of policies and procedures to most effectively manage and monitor Managed Care activities.
• Evaluate and model proposed financial terms, making recommendations based upon the financial analysis performed to prepare for counter proposals to payers.
• Present new contracts and or revised fee proposals to Manager for approval

Serves as Managed Care System Administrator by:

• Maintaining current knowledge base on benefit and network designs to act as service representative for internal and external contacts and maintaining payor database.
• Conduct and/or arrange regular education trainings for contracted managed care companies to ensure managed care provider tools and resources are known
• Coordinating and conducting training as needed for administrative staff.
• Maintaining information on the intranet site.
• Assess performance of contracted agreements for each Beacon Entity and communicate those findings to management to compose contracting strategies and goals yearly.

Supports the management team by:

• Providing input into the departmental strategic planning process.
• Working with sales staff and assisting with Requests for Information (RFI’s) as needed.

Perform functions for Beacon ACO and CHA ACO, LLC as directed.

• Completing other job-related assignments and special projects as directed.

ORGANIZATIONAL RESPONSIBILITIES

Associate complies with the following organizational requirements:

• Attends and participates in department meetings and is accountable for all information shared.
• Completes mandatory education, annual competencies and department specific education within established timeframes.
• Completes annual employee health requirements within established timeframes.
• Maintains license/certification, registration in good standing throughout fiscal year.
• Direct patient care providers are required to maintain current BCLS (CPR) and other certifications as required by position/department.
• Consistently utilizes appropriate universal precautions, protective equipment, and ergonomic techniques to protect patient and self.
• Adheres to regulatory agency requirements, survey process and compliance.
• Complies with established organization and department policies.
• Available to work overtime in addition to working additional or other shifts and schedules when required.

Education and Experience

• The knowledge, skills and abilities as indicated below are normally acquired through the successful completion of a Bachelor's Degree in Business, Economics, Marketing or a related field. A minimum of three years of managed care and group insurance experience, through which a background in Medicaid, Medicare and physician contracting was gained, is required.

Knowledge & Skills

• Requires a minimum of 5 years experience with direct payer, carrier, network and value based contracting for facilities and professionals.
• Requires knowledge of data analytic processes and interpretation of financial data sets as it relates to contract negotiation, payer and value based strategy.
• Requires an in-depth knowledge and understanding of employee benefit products/plans, including health/medical, dental and workers compensation, case processing (proposal, renewal, plan design, billing, claims, etc.) and the regulatory provisions of the Health Insurance Portability & Accountability Act of 1996 (HIPAA).
• Requires well-developed knowledge and understanding of PHO, HMO, PPO and POS healthcare delivery systems.
• Requires well-developed knowledge of Value Based programs, terminology and structure for both facilities and professionals.
• Demonstrates proficiency in basic computer skills (i.e. data entry, word processing, spreadsheets and database applications).
• Requires strong skills in organization, time management, research and analysis.
• Requires an in-depth understanding of contractual language, computer systems, accounting and finance.
• Demonstrates well-developed communication skills necessary to effectively communicate both verbally and in writing and to make presentations to individuals and small and large groups.
• Demonstrates a high level of interpersonal skills in order to ensure that effective relationships are developed, maintained and managed in a professional and effective manner with medical staff members, Hospital and System management team, patients, representatives of client organizations, business leaders, various public managers, physician groups and legal counsel.

Working Conditions

• Works in an office environment.
• May be required to vary hours and days, and work on holidays, etc., depending upon the needs of the department.

Physical Demands

• Requires the physical ability and stamina to perform the essential functions of the position.