Manager, Payer Contracting

Role Description

Under the direction of the Vice President of Managed Care Contracting, the Manager of Payer Contracting promotes and manages all managed care contracting efforts on behalf of the hospital and clinics. The Manager of Payer Contracting will be responsible for assisting with all payer contracting. The responsibilities include:

• Negotiating, implementing, and maintaining all payer contracts and the respective policies for each.
• Keeping abreast of all managed care marketplace activities and logically and cohesively adjusting strategies accordingly.
• Accountable for the negotiation, implementation, and contract performance tracking of all managed care contracts for the health system.
• Reviewing and analyzing contract language, including reimbursement methodologies and fee schedules.
• Maintaining the centralized contract repository and ensuring version control.
• Ensuring contracts comply with federal and state regulations and partnering with internal and external Legal teams to review terms to mitigate risk.
• Serving as the primary liaison between the organization and payer representatives.
• Supporting operational teams with contract interpretation and issue resolution.
• Supporting identification and resolutions of denials and underpayments.
• Identifying opportunity and negotiating supplemental payments.
• Tracking key contract metrics including payer mix, expiration/renewal dates, and reimbursement rates.
• Leading and maintaining collaborative payer and employer relationships and serving as the liaison to business, government, and the public in relation to managed care contract matters.
• Maintaining current knowledge of managed care principles and overseeing the achievement of targeted contractual levels.
• Identifying opportunities for improvement in managed care contracting and contractual performance with input from Case Management, Patient Financial Services, Registration and/or other departments.
• Overseeing the day-to-day collection of clinical, financial, and contracting data needed for the analytical support of the payer contracting process and hospital business development efforts.
• Serving as support role to the Vice President of Managed Care, accomplishing key tasks as assigned.
• Performing other duties as assigned.

Qualifications

• Bachelor’s degree required. Master’s degree preferred.
• Three (3) years’ experience in managed care contracting, experience working with Epic, and experience working with contract management software.

Requirements

• Knowledge of California and Federal rules related to managed care contracting, billing and compliance, and of population health and total cost of care.
• Proficient in Microsoft Office applications, including Excel, PowerPoint, and Word.
• Ability to operate office equipment, including printers, copiers, computers, adding machine, and fax machines.
• Excellent skills in dealing with members of the public, patients, and co-workers by utilizing positive communication, both written and verbal.
• Works effectively with administration, employees, and medical staff.

Benefits

• Union: Non-Affiliated
• Work Shift: Day Shift
• FTE: 1.0
• Scheduled Hours: 40