Position Reports to:
Sr. Director, Reimbursement/Managed Care
Job Summary:
Provide contract modeling and data and analytics support to the Senior Managed Care and Field Operations Team along with aiding in government and commercial contracting.
Key Responsibilities:
• Model hospital and ambulatory surgery center (ASC) contract proposals to gauge contract value and work effectively with the Reimbursement team throughout the negotiation process
• Perform reimbursement analyses to identify opportunities and highlight underpayment/denial issues
• Variety of ad hoc analytics projects revolving revenue optimization strategies in concert with Sr. Director Reimbursement and Field Operations
• Partner with Sr. Director of Reimbursement to provide strategic direction to Field Operations around reimbursement strategies, fee schedule management, payor contracting, etc.
• Contract for Tier II payors – Regionals, Managed Medicare and Medicaid, LOAs
• Develop, maintain and grow relationships with our partnerships’ clinical leadership team
• Own Contract Data Process
• Ensure contract methodologies, intent and other related data is properly loaded in managed care contracting database and communicated out to the entire field
• Dual signature and ownership of new rates for 90 days
• Provide education to the hospitals and ASCs on new reimbursement structures
• Coordinate OON analysis, audit and compliance with RCO and Compliance Team
• Track Revenue and volume shifts
• Manage CDM Process
• Coordinate/handle claims related contracted load issues
• Develop/standardize a process for claims ownership issues with RCO and Claims Resolution
• Develop Managed Care Tool Kit for SCA’s Knowledge Library
• Presentations to regions on various managed care tools
• Lead on-boarding of center level new teammates
Requirements:
• Ability to work with large amounts of data utilizing various software systems
• Understanding of the hospital, surgical hospital and ambulatory surgery center environment, particularly around various commercial and government reimbursement methodologies, insurance contracts, and payor systems
• Ability to interpret contract reimbursement’s impact on claims and utilization data
• Ability to translate data into meaningful presentations
• Ability to create and help execute initiatives based on data analytics
• Bachelor’s degree
• 5+ years payor contracting/reimbursement experience in healthcare industry
• Hospital and/or ASC operations experience a plus
To apply for this position, please click here:
http://ch.tbe.taleo.net/CH11/ats/careers/requisition.jsp?org=SCASURGERY&cws=1&rid=237