Region Manager Contracts Payer Strategy - California
Region Manager Contracts Payer Strategy - California
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Job Description
Overview
Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nations largest nonprofit Catholic healthcare organizations CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2300 clinics care sites and 137 hospital-based locations in addition to its home-based services and virtual care offerings. CommonSpirit has more than 157000 employees 45000 nurses and 25000 physicians and advanced practice providers across 24 states and contributes more than $4.2 billion annually in charity care community benefits and unreimbursed government programs. Together with our patients physicians partners and communities we are creating a more just equitable and innovative healthcare delivery system.
Responsibilities
Job Summary / Purpose
The Region Contract Manager for Payer Strategy & Relationships (PSR) assists PSR leaders in the development implementation and management of PSR system standards for contracting and payer relations. Accountabilities include: ensuring that managed care contracts are correctly negotiated and implemented for operational compliance across the division; implementing departmental policies and procedures that focus on maintaining positive working relationships with Payers and Providers; coordinating directly with internal & external stakeholders to ensure contract compliance on a regional and market level.
Essential Key Job Responsibilities
- Negotiates contracts with Payers on behalf of Providers with a focus on physicians and mid-level professionals and with Providers on behalf of capitated physicians. Contracts may include letters of agreement and single case agreements at the direction of senior leadership.
- Maintains supportive relationships with key departments that support the division in order to quickly resolve contract-related issues.
- Ensures complex payer information and reports are analyzed and summarized to provide timely operational and contracting recommendations for key internal leaders. Research contract and regulations to assist with claim payment issues and/or credentialing issues with payers.
- Drafts and summarizes content for official correspondence as issues arise with policy updates or compliance with agreements.
- Assists with updating project plan documents and communications plans.
- Monitors contract terms termination dates and rate update deadlines to assure proper and timely notification is achieved in compliance with project plan and strategy.
- Assists in developing tools/updates for communicating and operationalizing contract terms amendments and policy terms.
- Adheres to all established contracting guidelines. Contracting accountability for negotiation support include hospital physician and ancillary services.
- As applicable ensure standardized monthly quarterly and ad-hoc meetings with Managed Care Organizations occur and issues are resolved in a timely fashion.
- Participate in joint operating committee meetings with payers medical groups or providers as needed
Qualifications
Minimum Qualifications
Required Education and Experience
Bachelors Degree equivalent experience and/or education in Finance and health care may be considered in lieu of degree
Minimum of three (3) years of experience in Finance and/or health care contracting
Required Licensure and Certifications
If applicable additional certification(s) demonstrating industry knowledge in regulatory updates and their application to managed care payers such as provided by AAMAS or AAMN preferred.
Required Knowledge Skills and Abilities
- Knowledge and experience in reimbursement the financial aspects of contracting and managed care operations
- Effective project planning skills
- Excellent written and verbal communication skills
- Working knowledge of state and federal programs such as Medicaid and Medicare
- Working knowledge of various reimbursement methodologies including DRGs per diems RVUs
- Ability to effectively work within a highly matrix-oriented organization
Required Experience:
Manager
Employment Type
Unclear
