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Healthcare Contracting Manager in Memphis at Vaco

Date Posted: 5/14/2018

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    Memphis
  • Job Type:
    Health Care
  • Experience:
    At least 3 year(s)
  • Date Posted:
    5/14/2018
  • Job ID:
    141017

Job Description

SUMMARY

The Managed Care Contracting Manager serves as the conduit for Managed Care (payer) related issues between client and its contracted third-party payers. This position is responsible for organizing, understanding, and managing all managed care contracts. These responsibilities will be achieved by maintaining a database of all managed care contracts and associated insurance plans and understanding and interpreting the payer contract language and fee schedules. This position will oversee contract details, and be knowledgeable about the major provisions of agreements as they relate to day-to-day operations. Other functions include communicating with and educating our Revenue Cycle and Credentialing and Enrollment staff concerning contract provisions and assisting our operational areas when issues arise that need payer intervention. This position will work with the Director of Accounting to manage relationships with our provider reps and assist in analyzing our contracts and managed care issues logs when contract negotiations arise.

KEY RESULT AREAS (KRAs)

  • Analyzing reimbursements against our contract language
  • Assisting in provider relatioins
  • Managed care contract organization
  • Assisting in contract negotiations
  • Knowledge base for Revenue Cycle and Credentialing and Enrollment departments
  • Accounts Receivable issues support
  • Ability to analyze problems and effectively escalate when appropriate

KNOWLEDGE, SKILLS & ABILITIES, EDUCATION, and/or EXPERIENCE

  • Minimum of 3-6 years of relevant payer contract support required
  • Bachelor's degree in business, healthcare related field preferred
  • Managed care contract review and contract language interpretation required
  • Knowledge of Medicare/Medicaid/TennCare regulations, PPO, and HMO arrangements, third party payer protocols, and medical terminology
  • Knowledge of CPT codes, Resource Based Relative Value Scale (RBRVS), and Medicare reimbursement policies/practices
  • Strong organizational skills and detail-oriented with the ability to multi-task
  • High level critical thinking and problem-solving skills
  • Strong Excel and database management skills
  • Demonstrated high levels of initiative, innovation, and collaboration
  • Desire for process improvement
  • Analytical and goal oriented
  • Strong customer service orientation
  • Strong time management and priorities management skills
  • Excellent interpersonal, written and verbal communication skills