Managed Care Contract Analyst I Job at Driscoll Health
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General Purpose of Job:
Assists with the contract negotiating, and re-negotiating process of managed care contracts, as well as, support overall contract management and analysis for Driscoll Health System. Through research and analysis, the Managed Care Contract Analyst I will assist with establishing and maintaining contractual agreements between Driscoll Health System entities, and act as a liaison between entities to ensure stakeholders understand and interpret managed care contracts established by the health system. Additionally, this position will assist in managing, and coordinating the administrative, legal, operational, and financial opportunities related to contract negotiation and implementation for all areas of managed care.
Essential Duties and Responsibilities:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all-inclusive; employees will perform other reasonably related business duties as assigned by the immediate supervisor and/or health system administration as required.
The above statements should be included on all job descriptions.
List the job's essential or most important functions and responsibilities. Include all important aspects of the job - whether performed daily, weekly, monthly, or annually; and any that occur at irregular intervals. Standard functions listed below should be included on all job descriptions.
- Maintain utmost level of confidentiality at all times.
- Adhere to health system policies and procedures.
- Demonstrate business practices and personal actions that are ethical, and adhere to corporate compliance and integrity guidelines.
- Assist with the negotiation and renegotiation of managed care contracts for the health system to ensure the entities are jointly contracted with commercial insurance networks, health plans for government programs, and Solid Organ Transplant Networks, under supervision of departmental leadership.
- Ability to communicate effectively with all stakeholders across the health system, furthermore, disseminate manage care contract updates to key senior leaders across the health system.
- Coordinates the administrative, legal, operational, and financial issues related to contract negotiation for all areas of managed care.
- Maintains a comprehensive payor and managed care intelligence database; and maintain the managed care master contract files of fully executed contracts, related correspondence, and supporting documents.
- Build and maintain payor contract adjudication profiles within the system-wide electronic adjudication contracting tool
- Develops responses to request for proposals from managed care plans.
- Coordinates single patient agreements with the guidance of departmental leadership for contracted/non-contracted payers for health system services
- Facilitates the creation of managed care educational and training materials for payer contract services with health system admitting, patient access and billing representatives; physicians, physician office managers, clinic registration and billing representatives; and other participating provider personnel.
- Assembles, coordinates and manages the contract negotiation team including administrative, legal, finance, operations and others as identified.
- Prepare assessment of new payer relationship including a comparison to Driscoll’s standard terms and contract objectives.
- Recommends updates to managed care contracts and business terms as business environment dictates, and strategies change including Medicaid policy mandates and changes to state and federal law.
- Proposes alternate legal language as well as coordinate contract changes suggested by administration, operations, legal, risk and UM/QA.
- Evaluates opportunities and financial terms for the health system
- Maintains chronology of managed care proposals and counter proposals.
- Assist with assessing legal risks in the context of contract provisions. Drafts responses and fulfills requests for additional information needed by managed care plans representatives.
- Completes the development of proposals in response to managed care plan request for proposals.
- Assist with the strategic and financial judgment necessary to achieve profitable growth with payors.
- Reviews models that quantitatively evaluate plan financial impact of proposals to health system administration.
- Supports and participates in the continuous assessment and improvement of the quality of care and services provided.
- Participates in the development of annual budget and assists in developing contracting goals, strategies, activity plans and objectives.
- Coordinates with marketing department to develop and promote new products/services as well as build revenue in existing products/services.
- Coordinates with the health system Kidney Transplant Program towards the completion of various requests for information regarding essential transplant program data that is reviewed by solid organ transplant payers for contracting consideration.
- Assist departmental leadership in resolving managed care operational issues and provide interpretation of managed care contract language, terms and conditions.
- Participate in Revenue Cycle Support Services and Transplant Screening Committee as appropriate.
- Initiate and support the facility credentialing application process by sending, receiving, analyzing facility documents to determine appropriateness for the facility verification process
- Gather, verify, and evaluate confidential and sensitive organizational information, consistent with facility credentialing application requirements
- Effectively perform all aspects of the facility credentialing and verification process, to include initial and re-credentialing in a timely fashion
- Maintains a sense of professional and self-validation.
- Other duties as assigned.
Education and/or Experience:
Minimum of one year healthcare experience in a healthcare setting. Outstanding analytical ability and financial skills. Working knowledge of managed care operations and practices preferred. Working knowledge of health system admitting, billing, and utilization review as well as physician office practices, physician credentialing and physician billing practices preferred. Effective communication, organization, and interpersonal skills essential. Work independently. Excellent oral and written communication skills. PC skills necessary with experience in Microsoft Office products, including PowerPoint.
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