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Managed Care Contract SpecialistWestminster, California

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Job # 440325 Date posted 08/01/2022

Description

We are recruiting for a Managed Care Contract Specialist to join our Managed Care team.  This position will support our West Region and candidates will need to reside in Southern California. 

Summary:

Works with the Vice President of Managed Care and the Senior Director of Managed Care (SDRM) to achieve the goals of the Managed Care Contracting Department.  Helps coordinate and communicate the contract requirements to each facility within the market.  Responds to internal & external queries directly, and forwards others to appropriate Department staff when necessary. Has delegated responsibility for light contracting, as assigned by VP or SDMC. Participates in revenue cycle meetings and activities and serves as a liaison between managed care and the Revenue Cycle Team. Assists the SDMC in preparing documents and reports necessary for contract approvals and contract performance. Supports necessary functions to ensure contract integrity within the contract management system. Maintains and provides contract activity logs on a consistent basis.

Essential Functions:

  • Point person for Revenue Cycle Team.  Would participate and be key contact for Revenue Cycle monthly calls. Ensures that SDMC/ DOMCR has correct data parameters/ information before approaching payers.  Works closely with the Revenue Cycle team to identify trends.  Obtains details from cross functional teams, distributes challenges and necessary data to Payer and follow through on resolution; communicating any contractual issues to the SDMC. 
  • Sonata Management, responsible for loading contract terms, maintain contract profiles, tracking and monitoring to ensure contract integrity within the Managed Care Contract Database timely, accurately and if chronological order.
  • Intake contract requests and obtain all necessary details needed for SDMC to make initial contract evaluation and viability. 
  • LOA and Standing LOA’s - responsible for doing template LOAs which do not require negotiations.  This position will also serve as a backup when LOA Contract Manager is at capacity and when they are out of the office.
  • Assist the SDMC with the data input, attaching all relevant documents, i.e. modeling & Impact Analysis file into 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:  Manage/ track all Charge master communications and follow up with Payers. Collect any necessary amendments from payers for SDMC to review.  Uploads all necessary documentation to data base. 
  • Tracks the escalator provisions of the contracts, validates that Payers have updated their systems, updates the Managed Care Contract Database and notifies the core market operations with the new rates.
  • 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. 
  • Negotiates Tier Three Contracting and settlement agreements under direction of SDMC’s and others as assigned.
  • Manages payer contract signature process both internally and externally
  • VB relationships – this person will coordinate internal stakeholders and external meetings with our VB payer partners to ensure we are tracking success in meeting our metrics.
  • Maintains MC Key Payer Contact Data Base
  • Care Management meetings with payers, coordinate these clinical meetings with payers and pull together the information needed to drive conversion improvement, build trusted relationships, track activities and next steps
  • Respond to internal and external requests for information
  • MC Strategic Deep Dives: ensures all updates are entered in a timely and efficient manner (not sure about this one)
  • 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.
  • Monitors and communicates market intelligence on competitors

Knowledge/Skills/Abilities:

  • 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 and deadlines
  • Proficient computer skills
  • Ability to make presentations

Qualifications

Education:

  • Bachelor's degree in business or related field.

Experience:

  • Minimum of two (2) years healthcare and customer service management 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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  • Benefits and Recognition

    Benefits & Recognition Our goal is to offer valuable compensation and incentive programs that enables us to attract, reward, retain, and motivate highly qualified individuals. Compensation can include bonus plans and recognition for going above & beyond.

  • Healthcare

    Healthcare We offer a variety of Health Savings Account (HSA) and PPO plan options.

  • 401(k) Plan

    401(k) Plan Employees can contribute pre-tax dollars through payroll deduction.

  • Paid Time Off

    Paid Time Off Your work/life balance is important to us. We offer our employees a flexible Paid Time Off program.

  • Wellness Program

    Wellness Program We offer tools, resources and support for weight loss, stress reduction, smoking cessation and making overall healthier choices.

  • Community

    Community Community involvement is consistent with our company's principles and with our mission of customer service and quality care.

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