Managed Care Contracting Manager

Role Description

The Managed Care Resource will support our Home Health, Hospice, Private Duty and Senior Living Facility leaders in managed care contracting and revenue enhancement strategies for all healthcare payers as well as assist in the preparation for changes in the healthcare industry. The Managed Care Resource will negotiate managed care payer contract rates and terms and provide guidance with regards to the development of managed care relationships, ensuring timeliness and appropriateness of negotiated rates. Additionally, the Resource will negotiate contracts for new locations, assist with ensuring that contracts are updated for new services, manage contract terminations, conduct managed care education sessions and develop and implement a strategic vision to assist in accelerating the results of the Operations they will support.

Duties & Responsibilities

• Engage in complex levels of contract development and negotiation with managed care payors, including but not limited to managed care organizations, ACO’s, health systems, hospitals, physician organizations and third-party administrators while working with the Legal and Finance teams in analyzing margins based on costs and rates for existing and newly acquired operations.
• Establish, plan, direct and evaluate the implementation of tactical plan(s) that will ensure expansion and support of business operations into managed care relationships and brings consistency of contract-related criteria and guidelines to optimize financial performance and minimize risk for operations.
• Assist in analysis of contract terms and rates and coordinating the submission of amendments, changes in reimbursement, language changes and assist in advising each operation of risks and advantages of signing contracts.
• Identify, develop and maintain an effective relationship with managed care payors and managed care/health care regulatory agencies.
• Provide guidance and training when applicable to assist Field Operations partners in order to assist in accelerating the results of the Field.
• Monitor industry changes, market trends and events to proactively identify opportunities to increase and protect the operations managed care revenue as well as present as subject matter expert with regards to applicable changes in the healthcare industry.
• Coordinate and assist each operation with any issues such as contract cancellation and denials/appeals.
• Effectively communicate at all organizational levels and in situations requiring education, consultation, instruction, persuasion, negotiation and advisement as consultant will serve as internal managed care subject matter expert to Presidents, Executive Directors and Service Center leadership personnel.
• Teach, train and advise operational leadership on how to administer their managed care contracts by the creation and distributions of tools, training and resources for leadership, AR team, Intake personnel, Case Management and all other Operations or Service Center team members as needed.
• Assist AR team with high level managed care claims issues and projects to ensure timely collection of monies due.
• Serve as primary liaison for all operations by distributing to operations and service center all key contract terms and rates for all new and existing managed care payer contracts.

Qualifications

• Bachelor’s degree in business administration, management or health care administration preferred.
• 5 + years’ experience in managed care contracting with a managed care payer or provider organization.
• Analytically oriented with the ability to communicate complex financial matters in a concise, professional manner.
• Must be knowledgeable about the managed care environment; including Medicare Advantage, Commercial and Managed Medicaid products (HMO, PPO, EPO, POS and Special Needs Plans) as well as knowledge of Accountable Care Organizations (ACO’s) and value based purchasing strategies.
• Work collaboratively as part of the Managed Care Team.
• Knowledge of managed care payer contract language and terms, standard requirements and negotiated rate methodology to support contract compliance and analysis.
• Must be able to prioritize, plan, and handle multiple tasks/demands simultaneously and have strong analytical and problem solving skills with keen attention to detail and an aptitude for accuracy.
• Excellent verbal and written communication skills, as well as excellent critical thinking skills.
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
• Knowledge of Home Health, Hospice, Private Duty and Assisted Living Facility operations is a plus.
• Ability to be flexible, adaptable, and work in a rapidly and constantly changing environment.
• Knowledge of CPT-4, HCPCS, Revenue and ICD coding.
• Strong computer skills (MS Word, MS Outlook & Excel) with Smartsheet knowledge a plus.
• Must be able to travel.

Benefits

• Compensation: $95,000 - $105,000

Company Description

Pennant Services is one of the most dynamic and progressive companies in the rapidly expanding senior living, home health, hospice, and home care industries. Affiliates of Pennant Services now operate over 150 senior living, home health, hospice, and home care operations across 14 states, and we are growing! These operations have no corporate headquarters or traditional management hierarchy. Instead, they operate independently with support from the “Service Center,” a world-class service team that provides the centralized clinical, legal, compliance, risk management, HR, training, accounting, IT, and other resources necessary to allow on-site leaders and caregivers to focus squarely on day-to-day care and business issues in their individual agencies.

Something else that sets us apart from other companies is the quality of our most valuable resources – our people! We are dedicated to living out our culture as defined by our core values, “CAPLICO”:

• Customer Second
• Accountability
• Passion for Learning
• Love One Another
• Intelligent Risk Taking
• Celebrate
• Ownership

By incorporating these principles at all levels of our organization, our employees feel valued and excited about their impact on our service center team members and operational partners. Our culture fosters personal and professional excellence and promotes development that leads to continued success.