Contracts Manager

Job Description

Job Description

Come join an exciting and innovative company that puts the “care” back in healthcare!

At KabaFusion, our patients come from all walks of life and so do we.  We hire GREAT people, period!  Our culture celebrates and supports the differences that make us unique.  Here, it doesn’t matter what your role is, your hard work and dedication is not only recognized but celebrated.  Join us and find out why this is the place to excel and do your best work. 

 

About Us:   

What started as a single pharmacy in 2010 has grown into KabaFusion becoming the largest privately held home infusion company in the country.  We have a national network of pharmacies and nursing offices strategically placed to service 40+ states.  Couple that with over 30 years of combined experience and it’s no wonder why KabaFusion is the industry leader in home infusion. 

Job Summary
Responsible for oversight of the managed care contracts through implementation of systems assuring contract compliance, contract data management, and business development as it relates to health plans/payors. Overall field support will include but is not limited to credentialing, contract negotiations, contract interpretations and clarification, contract performance analysis, case management, education, and resources. Understanding claims process and intervention when required as support liaison between KabaFusion and health plan/payors. Basic understanding of current law and regulations, as may be directed by the VP of Managed Care and VP of Regulatory Compliance and Accreditation.

M AJOR DUTIES AND RESPONSIBILITIES:

1. Ability to establish and maintain professional business relationships with health plans contract managers
2. Knowledge and understanding of Division of Financial Responsibility of payors
3. Knowledge and understanding of various payor product lines
4. Knowledge of and routine review of contract language, terms, rates, and overall contract mechanics
5. Assure pharmacies remain fully credentialed with all payors to include management of documents required for credentialing and recredentialing process
6. Provide assessments and recommendations for contractual operation of managed care patients
7. Provide training support/resources to the field related to managing/analyzing contract costs
8. Knowledge of formulary fluidity, high-cost medications /supplies/DME and education/review of pharmacy costs to identify changes, exclusions, and guidance to internal stakeholders 
9. Implement cost reduction measures for the provision of ancillary services of managed care including pricing and rate analysis, formulary monitoring, recommendations, etc.
10. Assist with creation and implementation of managed care policies and procedures
11. Update/maintain managed care manuals, fee schedules and contracts
12. Ensure all documents and contracts meet company standards and are fully executed
13. Facilitate contract negotiation/renegotiation between health plans, medical groups, IPAs, or other managed care payor sources and KabaFusion’s reimbursement and finance leadership
14. Other duties as assigned

S K ILLS AND ABILITIES:

• Knowledge of managed care contracting billing and negotiations skills necessary
• Strong oral and written communication skills
• Strong problem-solving skills
• Exceptional computer skills in Microsoft Word, Excel, and Outlook
• Strong interpersonal skills to interface effectively with all levels of personnel
• Ability to maintain confidential company information
• Attention to detail
• Ability to self-direct work and effectively multi-task
• Exemplary follow up and follow through organizational skillset

E DUCATION AND/OR EXPERIENCE:

• Must possess at a minimum, bachelor’s degree in business or related experience
• Minimum of 7 years of experience in health care industry; infusion experience a plus
• At least 3 years’ managed care contracting, billing, and negotiations experience required

What we offer:  

• Competitive compensation 
• Benefits start on your 1st day of employment  
• 401k w 4% match – no waiting or vesting period  
• PTO / Floating Holidays / Paid Holidays 
• Company paid life insurance, short term disability
• Employee Assistance programs to help with mental health / wellness 
• Learning & Development Programs 
• Perks… includes discounts on travel, cell phone, clothing and more… 
• Generous employee referral program 

To learn more about KabaFusion, please visit our careers page: 

 

 

Join us and find out why this is the place to excel and do your best work.