Contracts Implementation & Systems Integration Manager
Contracts Implementation & Systems Integration Manager
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$ 75000 - 125000
1 Vacancy
Job Description
Job Details
Description
Position Summary
The Contracts Implementation and Systems Integration Manager will translate along with the Managed Markets team the contract agreements into operational reality for new fully executed Payor Agreements and existing payor agreements that have been delivered by the Managed Markets team. The Manager along with the Managed Markets team ensures correct onboarding compliance governance and integration across all departments of the Nufactor operations.
Essential Functions and Duties
- Along with Managed Markets leads full-scale end to end implementation of payer/provider agreements and provider manuals into operational processes workflows and systems within the Nufactor organization.
- Has thorough understanding of the CPR system
- Works with Nufactors multi-disciplinary teams to translate contracts into system functionality workflows and compliance programs by balancing input from Managed Markets Reimbursement Admissions and IT.
- Serves as a strategic liaison ensuring contractual and regulatory adherence across the organization.
- Works with Managed Markets and Reimbursement team to utilize the established relationships at the payor level to resolve any operational issues.
- Manages and adds all payors and contracts within Nufactors system of record to ensure proper claims processing.
- Understands eligibility requirements and authorization requirements of insurance company plans Medicare and Medicaid and how each program/payer reimburses.
- Works with Managed Markets to identify what is needed for payers to establish proper payment and processing procedures necessary for services.
- Works with Managed Markets and payers to establish proper payment and processing procedures necessary for services.
- Consistently analyzes operations and improves processes to provide better customer service and improve outcomes related to contracting and payer relations. Monitors performance of the payer process to ensure correct policy and procedures are being followed. This includes auditing current processes and providing recommendations and assisting in implementing changes to ensure compliance.
- Provides training and education to others in Nufactor Organization to ensure optimal revenue cycle capture and contracting. Provide direction to staff in expected reimbursement. Develop policies to guide and support the provision of billable services.
- Adheres specifically to all company policies and procedures Federal and State regulations and laws.
- Display dedication to position responsibilities and achieve assigned goals and objectives.
- Always represent the Company in a professional manner and appearance.
- Understand and internalize the Companys purpose.
- Display loyalty to the Company and its organizational values.
- Display enthusiasm and dedication to learning how to be more effective on the job and share knowledge with others.
- Work effectively with co-workers internal and external customers and others by sharing ideas in a constructive and positive manner; listen to and objectively consider ideas and suggestions from others; keep commitments; keep others informed of work progress timetables and issues; address problems and issues constructively to find mutually acceptable and practical business solutions; address others by name title or other respectful identifier and respect the diversity of our work force in actions words and deeds.
- Comply with the policies and procedures stated in the Injury and Illness Prevention Program by always working in a safe manner and immediately reporting any injury safety hazard or program violation.
- Ensure conduct is consistent with all Compliance Program Policies and procedures when engaging in any activity on behalf of the company. Immediately report any concerns or violations.
- Other duties as assigned.
Qualifications
Education Knowledge Skills and Experience
Required Education:
- Bachelors Degree in a related field.
- Advanced degree (MBA) preferred.
Preferred Knowledge:
- Familiarity with benefit verification and prior authorizations for specialty medications.
- Knowledge of reimbursement practice and electronic claims processing is preferred
Required Experience:
- Minimum of four (4) years experience in contract implementation account management project leadership preferably within health systems payers and provider networks.
Preferred Experience:
- Solid project management and cross-functional leadership often requiring coordination across multiple teams.
- Regulatory awareness knowledge of payer rules healthcare compliance and contract governance frameworks.
- Background in Pharmacy Benefit Management.
Required Skills:
- Must have strong organizational skills
- Must have a detail orientation and the proven ability to prioritize work
- Must have effective verbal and written communication skills
- Must have the ability to work with limited supervision and as part of a team
- Sound decision-making abilities
- Ability to prioritize work and make decisions independently and effectively often quickly in response to dynamic patient needs with limited supervision and direction except where required/restricted by law.
- Working knowledge of state federal URAC and TJC guidelines/regulations/laws.
- Ability to exercise discretion and maintain confidentiality to the level of required HIPAA standards.
- Ability to use and understand Microsoft Office skills and internet technologies.
Physical requirements
Vision hearing speech movements requiring the use of wrists hands and/or fingers. Must have the ability to view a computer screen for prolonged periods and the ability to sit for extended periods. Must have the ability to work the hours and days required to complete the essential functions of the position as scheduled. Must have the ability to lift and maneuver items of at least 20 lbs. Must have the ability to travel occasionally. Working condition include normal office setting.
Mental Demands
Learning thinking concentration and the ability to work under pressure particularly during busy times. Must be able to pay close attention to detail and be able to work as a member of a team to ensure excellent customer service. Must have the ability to interact effectively with co-workers and customers and exercise self-control and diplomacy in customer and employee relations situations. Must have the ability to exercise discretion as well as appropriate judgments when necessary. Must be proactive in finding solutions.
Direct Reports
No
EEO Statement
FFF Enterprises and Nufactor are an equal opportunity employer and prohibits discrimination and harassment based on the following characteristics: race color religion national origin physical or mental disability gender age (40 years and over) qualified veteran and any other characteristic protected by state or federal anti-discrimination law covering employment. These categories are defined according to Government Code section 12920. The Company prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has or is perceived as having any of those characteristics.
Required Experience:
Manager
Employment Type
Unclear
