Manager Payor Contracting McLaren Physician Partners

Responsible for managing Third-Party Payor contracting activities within all market segments for McLaren Physician Partners (MPP), McLaren Health Care Corporation (MHCC), McLaren High Performance Network (MHPN) and its subsidiaries. Working with leadership, conducts complex contract modeling and analysis with an understanding of population health and value-based contracting. Professionally and effectively communicates the advantages of contracting with McLaren, provides ongoing expertise throughout the contracting process and administration of payor agreements. Key team resource to the contract management team.

ESSENTIAL FUNCTIONS AND RESPONSIBILTIES

Responsible for managing contracting activities, including but not limited to review, redlining, and evaluation of language, and execution of the Managed Care contracts. Manages the contracting staff regarding contracting processes, workflows, and direction. Acts as a SME for all contracting activities of MPP, MHCC, MHPN and its subsidiaries, including providing ad hoc assistance and support as requested. Responsible for review and resolution of billing, utilization review and administrative issues with Third Party Payors. Analyzes changes in payer policies, rules and regulations impacting both facility and physician payments. Communicates and educates those impacted as necessary. Makes recommendations to maintain regulatory compliance and internal controls as required. Participates in and may lead during negotiations. Identifies any issues and coordinates contract workflow/approval through to contract execution and administration of contracts. Motivates staff; defines priorities and communicates to staff organizational goals and works with them to achieve them; seeks commitment from staff, encourages innovation and team building/planning. Required Bachelor’s degree in business, health care or related field. Five (5) years’ experience in progressively more complex provider contracting and servicing in a managed care organization, Health Plan, PHO, PO or similar organization, including two (2) years’ experience with standard and innovative contract and reimbursement methodologies, including but not limited to fee for service, value-based payments, risk contracting, capitation and bundled payments. Preferred Two (2) years in a leadership role of a professional staff or a progressively more responsible lead role leading complex projects, workflow management, etc. Established relationships with Health Plans, other Industry Professionals. #J-18808-Ljbffr McLaren Health Care