Managed Care Contract SpecialistWestminster, California
We are recruiting for a Managed Care Contract Specialist to join our Managed Care team. This position will support our West Region.
Works with the Vice President of Managed Care (VPMC) and the Senior Director of Managed Care (SDRM) to execute the Managed Care team’s strategic initiatives and contracting goals. Coordinates and communicates across various functional teams to support the necessary contracting needs for each of Kindred’s facilities and markets within their assigned area. Will have responsibility for light contracting, as delegated by VPMC or SDMC. Participates in various meetings and activities as required by the managed care and operational teams within their assigned areas. Serves as a liaison between Managed Care team and the Revenue Cycle Management (RCM) team to support A/R initiatives. Assists the SDMC in preparing documents and reports necessary for contract approvals and contract performance. Responsibility for maintaining Kindred’s contract management system (Sonata), to include loading of contracts and maintaining integrity of the system. Maintains accurate record of all contracting activity and provides reports on a consistent basis to Kindred’s leadership.
- Point person for Managed Care with RCM team related to A/R initiatives. Participates in Revenue Cycle monthly calls and works closely with the RCM team to identify payer trends. And communicates appropriate contractual issues to the SDMC. Obtains details from cross-functional teams to ensure the managed care team has appropriate data & information necessary to address non-payment issues with payers.
- Responsible for timely loading of contract terms and accuracy of contract profiles within Sonata; tracking and monitoring of contracts within the system and provides reports to leadership as requested.
- Manages the intake of contract requests and obtains all necessary details needed for SDMC to evaluate contract need, viability, and prioritization within the workflow que.
- Assist the SDMC with the data input, attaching all relevant documents, i.e., modeling & Impact Analysis files in SharePoint Contract Activity Log.
- Special Projects Coordinator: Including but not limited to location changes, facility name changes, facility closures/ divestitures, new facility openings. Responsible for uploading supporting documentation to data base.
- CDM notices & updates: manages & tracks all Charge Master Updates, communications and follow up with Payers. Collects necessary amendments from payers for SDMC to review. Uploads all necessary documentation to data base.
- Tracks escalator provisions of contracts; validates when payers have updated their systems; updates the Managed Care Contract Database; and notifies operations leaders of rate changes.
- ARU Expansion: Under the direction of the SDMC manages contract negotiations for Tier 2 & 3 payers and responsible for communicating progress on all ARU Activity to internal teams.
- LOA and Standing LOA’s - responsible for standard template LOAs which do not require negotiations; serves as backup to Contract Manager as necessary and as assigned.
- Negotiates Tier Three Contracting and settlement agreements under direction of SDMC’s and other contracting duties as assigned.
- Works with RCM team in coordinating testing and monitoring of claims process with payers to ensure unique and non-customary contract rate terms are appropriately billed.
- Manages payer contract approvals and signature process both internally and externally.
- Supports value-based (VB) initiatives: coordinates with internal teams in preparing for external meetings with our VB partners and tracks success metrics, as defined by VB agreements.
- Care Management Functions: internal communication with case management teams of new and unique contract terms (carve-outs); assists with care coordination meetings with payers; tracks and monitors such activities in appropriate logs.
- Participates in Managed Care Strategic Deep Dives. Ensures all updates are recorded and entered in a timely and efficient manner and uploaded to Strategic Planning folder in KNECT.
- Maintains and provides contract activity logs on a consistent basis and shares with appropriate department leadership.
- Provides information necessary for preparing data & reports for Quarterly Operations Reviews.
- Responds to all internal and external requests for information.
- All other duties as assigned by the Senior VP of Strategy & Network Development, MCVP or SDMC.
- Self-motivated and results oriented
- Strong organizational and interpersonal skills, including the ability to work collaboratively with various colleagues to achieve defined market-specific goals
- Ability to apply knowledge of payer contract terminology and payer reimbursement methodologies including managed care requirements and strategies
- Ability to communicate in English effectively through verbal and written means
- Ability to work under stress, meet deadlines, and respond to urgent requests.
- Proficient computer skills (outlook, word, excel, power point).
- Ability to create professional presentations.
- Bachelor's degree in business or related field.
- Minimum of two (2) years healthcare and customer service management experience or equivalent provider relations experience.
- Minimum of two (2) years experience in general payer contracting.
- Knowledge of the Post-Acute industry preferred but not required.
Depending on Candidate’s qualifications, we may fill at a different level.
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