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Midwest Orthopaedics at RUSH is fast paced growing organization. We are looking for Reimbursement Specialist to join our organization.

The qualified individual should have a positive attitude, a willingness to learn new duties and work together with our existing staff as a productive member of our team.Duties include:1.Answers incoming calls into call center and assists patients/insurance companies with account questions in a courteous and timely manner. Ensures patient/insurance companies understand the billing statements and processes to provide the highest level of customer care. 2.Works the accounts effectively and efficiently.3.Works and resolves all incoming correspondence in a timely manner. 4.Follows-up with insurance companies/patients regarding claim/payment status through practice management system and reporting tools.5.Documents all actions and maintains permanent record of patient accounts.6.Reviews and adjusts balances according to fee schedule and Management/MD requests7.Identifies and corrects patient account and insurance errors.8.Researches and obtains necessary documentation for insurance companies to process outstanding claimsCooperation & Attitude:9.Supplements office staff when requested and is receptive to additional assignments/projects as delegated by supervisor.10.Maintain a positive demeanor with patients, peers, supervisors and physicians, especially when receiving feedback or direction.Teamwork:11.Assists staff members when necessary in a positive and professional manner to ensure the patients receive the utmost in care.Accuracy:12.Performs work with accuracy to minimize error correction by other staff members.Organization:13.Organizes and prioritized work to make sure projects are completed in a timely and efficient manner. Requirements: High School diploma or equivalent. At least one year of experience in medical reimbursement/collections.

The Region has recognized the importance of an Associate Contract Manager function to assure successful contractual relationships with hospitals and community providers. This position will be responsible for both fostering relationships with hospitals, community physicians and The Southeast Permanente Medical Group, Inc. (TSPMG). There is clearly a need to establish a position whose primary function is to act as liaison between contracted hospitals (as assigned), community providers and the Program and address issues related to contract administration.Minimum education and experience requirements:-Bachelors Degree required-Thorough knowledge and understanding of provider relations, physician reimbursement and managed care contracts-Knowledge of physician office operations (example::CPT-4 codes, ICD-9 codes, capitation etc)-Five years experience in provider contracting/provider relations -Experience in billing department protocol and procedures-Must have 2 years experience in a field position-Must have 2 years of public speaking and presentation skills-Proficient in Excel and Word-High ethical standardsPreferred education and experience:-BSN preferred-Knowledge of Medicare, Medicaid, regulatory requirements and practice protocols-Knowledge of quality assurance and utilization management concepts-Knowledge of KFHP contracting process, benefits coverage, QA goals and objectives, medical referrals processing procedures

Contracts Specialist

Overview:Provide skilled professional duties relating to the initiation and completion of contractual arrangements entered into by and on behalf of TCH entities.- Coordinate vendor selection, contract initiation and negotiation, and contract review and approval processes for business arrangements.- Responsibilities:Coordinate, draft and finalize RFI and RFP.- Review request and determine whether existing contracts or internal resources may be leveraged to meet requirements; outline, verify and document roles, scope of work specifications, timelines and expectations; prepare contractual agreements; coordinate draft contract review and make necessary edits, formatting and grammatical changes; develop negotiation strategy and lead negotiation team in dealing with vendor regarding price and other contractual issues; prepare final draft of contract, complete approval documentation, distribute for final approval and obtain original vendor signature, legal stamped approval and TCH signature; monitor progress of contract review and approvals; ensure dates and documents are updated in the contracts database; complete contracts within times assigned; assist in the revision/correction and uploading of contract templates.- Answer customer questions regarding TCH contracts process; maintain positive working relationships with customers and vendors.- Demonstrate and maintain strong professional knowledge of contracting, negotiating and area of specialty.- Edit and maintain RFI, RFP and contract files.- Input and maintain purchase orders that directly relate to assigned contracts.- Collaborate with others to improve effectiveness of the contract administration function.Knowledge and Skills:Thorough knowledge of and experience with RFI, RFP, vendor evaluation, vendor negotiation, contracting and contract terms and conditions required.- Experience with and understanding of at least one of the following contract specialist specialty areas: Sourcing & Procurement, Biomedical Engineering or Information Services desirable.- Knowledge of hospital equipment, supplies and associated purchasing practices, procedures and techniques is also helpful.- The ability to read and interpret complex contractual agreements required.- Must be able to communicate (verbally and written) effectively with vendors, TCH leadership and end users.- The ability to effectively utilize computer word processing and spreadsheets software required.- Must be able to organize information, generate reports and make recommendations on actions needed.- Must be able to effectively prioritize and manage multiple projects and tasks, meet timelines and be customer-service focused and detail oriented.- Education, Licensure and Experience:Five (5) years experience in contracting, preferably in a healthcare environment and a Bachelor´s degree in business or related field.- Must have and maintain certification from a recognized national contracting professional organization.- Extensive knowledge of purchasing and contract laws required.

The primary function/responsibility of the Network Manager will be to support the contracting activities of the Medical Group and Health Plan. Contracting activities continue to grow substantially in volume, financial impact and complexity. Existing contracts must be continually renegotiated and aggressively managed. The Network Manager position is expected to manage outside medical cost for the Kaiser Permanente Health Plan through contracting initiatives, analysis of financial reports and trends in the marketplace. Areas of responsibility will include IPA´s, PHO´s, hospitals and key specialty services. Contractual arrangements will be complex and comprehensive, needing a depth of understanding of managed care; and a miminum of 5-7 years of negotiation in hospital, PHO/IPA and various high volume services.The minimum requirements for the successful candidate will be:• BS/BA in Business Administration, Finance or Healthcare • MBA or MHA preferred • 7-10 years experience in Health Care Administration, Managed Care Contracting or Health Care finance a plus • Must possess a successful track record of negotiating large hospital system contracts • Ability to budget and obtain necessary medical cost targets • Strong understanding of financial reports and the ability to manage accordingly • Must understand contract language and legal requirements for contracting • Strong understanding of State and Federal Laws related to provider contracts • Strong understanding of Medicare contracting and reimbursement methodology • Broad based knowledge of healthcare and the various medical delivery systems • Understanding of various financial reimbursement methodologies used in managed care contract is required- CMS DRG´s, Revenue Codes, APC´s, RBRVS and ASC Groupers • Negotiation and analytical skills are necessary • Excellent organizational and prioritization skills, the ability to work under tight deadlines, high productivity are required • Strong written and excellent communication skills • Management skills required with the ability to manage a team of field representatives • Strong presentation skills • Ability to interact with senior leadership team and provide recommendations on contract strategies and cost • Expert knowledge of Excel, Access, Power Point and Contract Management system • Strong Project Management skills

Adena Health System is seeking a Director, Managed Care Contracting. This multi-hospital system (300+ beds and a 150 physician employed group), located just 45 miles south of Columbus OH, is seeking expertise in the realm of Managed Care Contracting.

Adena Health System, has assembled an impressive leadership team and is looking for a highly skilled executive to direct managed care contracting. CEO Mark Shuter was President & CEO of Riverside Methodist Hospital (flagship hospital for OhioHealth) prior to joining Adena in 2005. Keith Coleman, CFO, was previously President, University Hospitals Faculty Services for Case Western Reserve/ University Hospitals in Cleveland and had served as CFO Geisinger Health System. They have created an aggressive vision and are looking for a solid managed care contracting leader to join their dynamic team.The Director will be responsible for managing and leading all contracting activities including the analysis, evaluation, assessment, development and negotiation of contractual arrangements; negotiation and implementation of carrier arrangements; audit, analysis and oversight of reimbursement performance; and development of collaborative relationships with all third party payers. The Director will also work with leaders in revenue cycle and professional fee billing to implement systems and processes to optimize reimbursement and ensure compliance with managed care contracts. The successful candidates will possess a Bachelors Degree in Business, Health Administration or related discipline. Must have 10 years of experience overseeing managed care contracting, reimbursement or provider relations with a strong track record of success. Solid analytical skills with ability to negotiate and persuade is key to the success of this role. Experience working in a complex organization is a plus!

The Executive Director reports to senior VP of finance/CFO. This position manages the day-to-day business operations of the network, develops a clinical integration plan and coordinates clinical integration through medical management, evaluates costs and benefits of potential contracts and assesses ongoing financial implications of current contracts and their effect on the network, as well as negotiates, maintains and monitors all provider contracts. Qualified candidates will be experienced in managed care contracting, medical staff relations, and possess a comprehensive knowledge of managed care, reimbursement, contracting, provider networks and associated legal issues. A bachelors degree in business, health administration or related field is required, masters preferred.The regional healthcare network of primary and specialty care physicians, hospitals, and allied healthcare professionals provides services for an eleven county area. They have integrated the delivery of healthcare services between network members, health plans, payers, and businesses in the communities served. The Network contracts with most health plans and payers in the region. These plans include HMOs, PPOs, and network only or broker arrangements. They also contract directly with employers and community business coalitions. The network membership now includes over 275 physicians, 4 hospitals, 48 different specialties, and a full range of other medical services. The flagship hospital is a 321-bed, not-for-profit, academic, Magnet-designated facility. The hospital serves as a regional trauma and referral center for such specialties as cancer, cardiology, open heart surgery, spine and neurological disorders, gastroenterology, orthopedic surgery, rehabilitation services, plastic and reconstructive surgery, and laser surgery. The Community of 79,000 residents enjoy the combination of big-city amenities with the look and feel of the great Northwood´s and small-town hospitality. Enjoy a healthy and diverse economy, award-winning educational institutions, an abundance of retail shopping, and numerous cultural and entertainment events, in addition to the comforts and conveniences of small town life affordable housing, friendly people, and low crime. Residents take pleasure in four distinct seasons that offer year-round beauty and recreation that includes golfing, fishing, canoeing, snowmobiling, skating, as well as downhill and cross-country skiing. This is an ideal place for families.

Identify prospective managed care contracts, negotiation, and rate determination for the Duke Univ. Health System (3 hospitals, 2 ambulatory surgery centers, 2 retail pharmacies, 90+ employed physician group, home health, home infusion, and hospice).

Experience with solid organ and bone marrow transplant contracting preferred.Oversees the data collection function for both prospective contracts and current contracts and assists in the analysis of that data. Initiates the renewal process as appropriate. Performs these functions in accordance with established policy and procedure. Interacts closely with various Duke University Health System components to maximize operational efficiency in the administration and revenue maximization of all managed care contracts. Duties and Responsibilities of this Level:Responsible for the development and management of negotiations for managed care contracts in a manner consistent with the Health Systems strategic approach to managed care, including:Evaluation of new contracting opportunities, including substantive and pricing components, for the Health System.Management of financial, operational, and legal analysis of proposed managed care agreements.Serve as the primary negotiator in managed care negotiations. Negotiates contract rates and provisions in accordance with established Health System policy and procedure.Assist in the organization of site visits for payers, third party administrators, as required.Assist in the development of the necessary systems to support the data and analysis needs of managed care contracting. Responsible for assisting in the implementation of managed care contracts, including: Coordinate with Patient Revenue Management Organization the contract implementation process for appropriate internal audiences, including hospital and professional administrative and professional staffs. Identify and recommend appropriate changes in operating procedures and systems that might be required to accommodate a managed care contract. Assist in the scheduling and facilitating of orientations/workshops with payers/third party administrators for Health System personnel. Interacts closely with various Duke University Health System components to maximize operational efficiency in the administration and revenue maximization of all managed care contracts.Responsible for monitoring the performance of managed care agreements, including: Development and maintenance of quarterly management reports for Health System senior management analyzing managed care activities, contract trends, costs and profitability. Monitor managed care companies compliance with contractual requirements of the managed care agreements. Responds quickly and effectively to negative trends. Evaluate existing agreements and report findings/recommendations to renegotiate/modify/terminate contractual relationships to Assistant Vice President, Managed Care. Meet with plan representatives to discuss ways to strengthen existing relations.Responsible for assisting the Assistant Vice President, Managed Care in developing the strategic managed care plan for the Health System, including: Serve as a liaison to Health Systems Clinical Service Unit managers in the strategic planning process. Interact with all Health System components in the development and implementation of managed care initiatives. Responsible for representing the Health System to external audiences at conferences, presentations, workshops, association meetings, community events, etc., including: Represent the Health System to managed care entities in day-to-day customer service relations. Performs other assigned responsibilities and projects as delegated by the Assistant Vice President, Managed Care. Develops and implements a personal development program to ensure continuing professional growth.Required Qualifications at this Level:Education:Bachelors degree in Business Administration, Health Care Management or related field. MBA and/or MHA highly desirableExperience:A minimum 5 years of hospital, physician and alternate site managed care contracting experience for commercial, Medicare, and Medicaid. Minimum 2 years of experience with solid organ and bone marrow transplant contracting preferred.Knowledge, Skills, and Abilities:Excellent direct negotiation, analytical, verbal and written communication skills. Ability to prioritize, works well independently, and handles multiple projects simultaneously. Direct experience with financial analysis and contract analysis highly desirable. Must be knowledgeable regarding health care, managed care concepts, third party payer contract terms and legal issues, financial analysis, and the medical reimbursement environment. The position must be able to facilitate and problem solve at multiple levels within the organization. The position must be able to appropriately represent the organization to external audiences. Must stay abreast of managed care developments through professional associations, trade publications, and consumer groups. Experience with IBM-PC software packages (Lotus Notes, Word, Excel, and Access).