Your search returned 9 jobs

The Payer Contracting Analyst performs financial analysis of payer reimbursement, contract performance, and contract proposal development.

POSITION OBJECTIVE: The Payer Contracting Analyst performs financial analysis of payer reimbursement, contract performance, and contract proposal development. The Payer Contracting Analyst utilizes established tracking tools to follow contract negotiations, and documentation of executed amendments and contracts to ensure accurate implementation. Develops and maintains key payer contract information in database to ensure timely renewals, renegotiations, and availability of information necessary for auditing. Provides support in payer contract negotiations and language review as directed by Director, Payer Contracting during operation preparations and management phases and provides overall payer contracting and implementation support to ASC/hospital clientsKEY ACCOUNTABILITIES:- Financial analysis of payer contracts, contract proposals and contract performance.- Tracks payer contract renewal dates, and works with Director to prioritize contract re-negotiations based on specified parameters. - Analysis of governmental payers by market (Medicare, Medicaid, TriCare, Work Comp.). - Assists in analysis and recommendations to Director, Payer Contracting, ASCs, hospital clients, and operations team for reimbursement and contracting strategies.- Coordinates, and implements the administrative infrastructure required to effectively manage network-wide payer contracts.- Assists in the development of educational programs for ASC clients on payer contracts and payer-relations issues- Obtains comprehensive understanding of ambulatory surgical center operations including reimbursement, pricing, and cost of services.- Maintains effective payer relationships within all of Health Inventures markets.- Implements processes, procedures and methodologies to be used by payer contracting in order to improve overall internal and external systems as directed by Director, Payer Contracting.- Serves as a managed care resource to accounting, business development, operations, finance, management and executive team.- Responsible for oversight of implementation of payer contracts and crosswalks in software programs to adequately track reimbursements.- Coordinates with finance and accounting to ensure accuracy of net revenue calculations.- Coordinates with Business Office Consultant, Administrators and ASC Business Office Staff to audit performance of contracts and develop appropriate reports for Boards.- Responsible for ongoing client relations with payers to ensure performance of contracts and high quality of annual service to clients per management agreements.- Coaches and/or trains Administrators and ASC Business Office staff on payer contracts and reimbursement as directed by Director, Payer Contracting.- Negotiates payer contracts for ASC sk as directed by Director, Payer Contracting.- Coordinates with ASC Administrators to ensure credentialing with payers is completed.- Team Member in meetings and contract discussions with Payers.- Other duties and special projects as assigned. - Ensures compliance with all Health Inventures policies and procedures.- Performs in a manner consistent with Health Inventures’ value and mission statements.SKILLS REQUIRED:Interdependent Partnering- Ability to work cooperatively and openly with the operations, accounting and business development teams- Excellent interpersonal and communication skills with the ability to maintain effective communication with center administrator, business office managers and other members of the management team- Ability to function in a team-orientation environment- Ability to interact with a team of individuals with diverse skills- Excellent written and verbal communication skills- Ability to make effective presentations to small and large groups- Ability to utilize external information sources and internal resources while performing research in support of project work- Willingness to participate in and support career development processMastering Complexity- Ability to manage complex project schedules- Excellent analytical and problem-solving skills- Excellent organizational, prioritization skills and time management skills- Ability to organize and follow through on own initiative and accomplish multiple tasks- Strong negotiation and conflict resolution skillsCustomer/Marketplace Focus- Knowledge of ASC operations including: reimbursement, pricing, managed care and cost of services- Strong understanding of healthcare market dynamics and regulatory environment- Strong understanding of company products, services and clients- Knowledge of competitors and payers- Ability to understand client needs and serve as client representative in development projects Innovation- Knowledge and mastery of various disciplines needed to manage outside vendors - Ability to generate creative ideas for use in client deliverablesTechnical/Functional- Strong financial and data analysis skills- Advanced level of proficiency in Microsoft applications including with high level of proficiency in Excel- Demonstrated knowledge of Intranet/Internet for the purpose of accessing key data and conducting data searches and assembling research material- Knowledge and of healthcare facility development- Advanced project management skillsEducation:- Bachelor’s Degree from an accredited university preferredExperience:- Three to seven years managed care experience, financial contract analysis. Third-party payer contracting and negotiations required- Experience with and coordination of project team members such as hospital executives, and operations staff requiredWork Environment: (e.g. office, field, ambulatory surgery center, hospital)- Professional OfficePhysical Demands: (e.g. works on a computer, use telephone, lifts up to 50 lbs.)- Works on personal computer- Uses telephone and office equipment- Ability to travel

CONTRACTING DIRECTOR, Payor Relations & Physician CredentialingOrlando, FLPosition is available with a multi-speciality physician practice in Orlando, Florida. Requires a minimum of five (5) years medical contracting experience. Incumbent will collect and analyze data, evaluate contracts and reimbursement and interact with contracted payors to resolve operational/contracting issues. Will also be responsible for timely and accurate physician credentialing.Position requires a bachelors degree in healthcare management /business administration or related field.

The Seton Family of Hospitals, a not-for-profit organization, is the leading provider of healthcare services in Central Texas.Seton is building for the future providing ´Healthcare that Works and Leaves No One Behind.´

Responsibilities 1. Provides department leadership for physician contracting through initiation, review, and analysis of physician managed care contract terms to include reimbursement terms. 2. Negotiates contracts on behalf of Physician Enterprise NPHO physician groups based on contract parameters provided for the respective groups. 3. Provides management oversight of NPHO physician contracts to ensure they are implemented according to the contract terms. 4. Manages and oversees system for physician contract modeling and physician revenue projections. 5. Identifies opportunities for contractual improvements and addresses through annual renegotiations. 6. Establishes and maintains positive, collaborative working relationships with representatives of the managed care plans, NPHO physician groups, and MSO staff. 7. Supports NPHO physician groups regarding credentialing timelines and processes of each plan to ensure physicians are participating with the contracted payors. 8. Monitors contracts with NPHO physician groups and enforces the contract terms when necessary by addressing them with Seton leadership and appropriate plan representatives. 9. Collaborates with hospital contracting leadership to ensure a coordinated negotiation for both physician and hospital facilities. 10. Maintains proficiency in negotiating variable fee schedules based on RBRVS, Medicaid, and hospital pricing. 11. Protects the confidentiality of all assigned Network contract projects. Minimum Qualifications Bachelors degree is required. Five (5) years of experience with physician managed care contract negotiation and administration is required. Preferred Qualifications Masters Degree Preferred. Proven leadership and relationship building skills. Ability to communicate clearly and effectively with both managed care plans and physician groups. Extensive knowledge of various fee methodologies and fee schedules across many physician specialties. Ability to analyze and compare fees across methodologies. Ability to negotiate contracts based on analysis, ability to implement and enforce contract terms. Skills Proven ability in establishing and maintaining positive and collaborative working relationships with leadership, including physicians and managed care plans. Possesses leadership in negotiating, implementing, and enforcing contract terms. Must have extensive knowledge of variable fee schedules and ability to analyze schedules based on different models. Physical Demands Sedentary (Requires lifting up to 10 lbs and carrying small objects) Standing................................ Constant Walking................................. Constant Sitting.................................... Constant Reclining.............................. Not Required Lifting-floor to table............. Constant Lifting-table to shoulder..... Constant Lifting-above shoulder......... Constant Lifting-by weight-10 lbs...... Constant Carrying................................ Constant Pushing................................ Constant Pulling................................... Constant Climbing............................... Occasional Balancing............................. Frequent Stooping/Bending................ Frequent Kneeling............................... Constant Crouching............................ Not Required Crawling............................... Not Required Reaching.............................. Constant Handling................................ Constant Finger Dexterity................... Constant Feeling................................. Constant Talking................................. Constant Hearing................................ Constant Tasting/Smelling................. Not Required Vision.................................. Constant Depth Perception................ Frequent Field of Vision.................... Constant Work Environment Experiences no exposure to blood and blood-borne pathogens in job Supervision Received Executive Director-Plan Administrator SPHN Supervision Exercised None Physical Other N/A Other Functions 1. Performs other duties as assigned.

SHP Publicly Supported Health Care Responsibilities 1. Performs needs analyses, researches and assists with or drafts SHP policies and procedures for contracting functions. 2. Creates, maintains and audits provider database including contract relationships, specialty data and demographic information. 3. Conducts ongoing needs assessment to provide continuous quality improvement including focus groups, surveys, and audits of existing procedures. 4. Communicates plan information alerts including policy changes to provider panel. 5. Coordinates and participates in special projects requiring a multi-disciplinary approach. Becomes familiar with other SHP service areas (such as Government Programs Readiness Review), is accountable to determine needed support by these areas and provides that support as needed. Minimum Qualifications Bachelors degree in business-related field is required. Previous experience in contracting and provider relations communications is preferred. Prior Internship in Managed Care (HMO/PPO) environment is preferred. Physical Demands Sedentary (requires lifting up to 10 lbs and carrying small objects) Balancing:............Rarely Bending:...............Occasionally Carrying:...............Occasionally Climbing:.............Rarely Crawling:..............Rarely Crouching:............Rarely Fine Dexterity:.......Continuously Foot Controls:.......Rarely Handing:..............Occasionally Hearing:...............Continuously Kneeling:.............Rarely Lifting:..................Rarely Pushing Pulling:.....Rarely Reaching:............Occasionally Sitting:...................Continuously Standing:..............Occasionally Talking:................Frequently Twisting:..............Rarely Vision:..................Continuously Walking:...............Occasionally Work Environment Experiences no exposure to blood and blood borne pathogens in job Supervision Received Director of Client Services

The Seton Family of Hospitals, a not-for-profit organization, is the leading provider of healthcare services in Central Texas.Seton is building for the future providing ´Healthcare that Works and Leaves No One Behind.´

Responsibilities 1. Manages physician, facility, ancillary, and other required health care services contracts to ensure network goals/objectives are met. Management includes initiation, review, implementation, and monitoring of health plan contracts. Additionally monitors provider network accessibility. Identifies gaps in coverage and works to close those gaps. 2. Establishes and maintains positive and collaborative working relationships with health plan contracted parties. Manages the liaison between Seton Health Plan staff, contracted IPAs and physician networks, group practices, individual physician practitioners, facilities, ancillary providers, and other health care providers. 3. Assist in the training and development of health plan staff as it relates to health plan contracting. 4. Maintains contracting standards in compliance with appropriate State and Federal regulatory requirements and assumes administrative responsibility and accountability for those standards. 5. Builds and maintains provider file and fee schedules in health plan claim system. Supports health plan departments in resolving health plan contract issues and questions. 6. Supports health plan operations by supplying fee schedule and provider file information to health plan contracted administrative vendors. 7. Maintains proficiency in, and negotiates variant fee schedules including but not limited to RBRVS, RVU, Medicaid, and hospital pricing: per diems, case rates, ambulatory surgery fee schedules. 8. Serves as a contracting information resource and consultant to health plan leadership and staff as needed. 9. Completes fee schedule requests from plan providers. 10. Protects the confidentiality of all assigned Network activities. Minimum Qualifications One year of college is required. Bachelor degree preferred. Four (4) years of relevant experience in an appropriate discipline is required, demonstrating increased responsibility within the experience. Experience in contract development and monitoring is required. Preferred degree can substitute for two (2) of the required years of experience. Preferred Qualifications Bachelors degree preferred. 1+ years of physician contracting experience a plus. Strong negotiation skills and the ability to communicate clearly and effectively with managed care plans and physicians in writing and verbally. Proven relationship building skills. Knowledge of various reimbursement methodologies and the ability to analyze and compare physician rates among methodologies. Knowledge of fees/reimbursement levels across many physician specialties. Skills Knowledge of variant fee schedule methodologies is required. Decision-making, team development and the ability to facilitate among various staff groups. Strong negotiation and relationship building skills a must. Ability to communicate clearly and effectively in writing and verbally. Physical Demands Sedentary (requires lifting 10 lbs, carrying small objects) Balancing:............Occasionally Bending:...............Occasionally Carrying:...............Occasionally Climbing:.............Rarely Crawling:..............Rarely Crouching:............Occasionally Fine Dexterity:.......Occasionally Foot Controls:.......Rarely Handing:..............Occasionally Hearing:...............Frequently Kneeling:.............Occasionally Lifting:..................Rarely Pushing Pulling:...Occasionally Reaching:............Occasionally Sitting:...................Frequently Standing:..............Frequently Talking:................Frequently Twisting:..............Occasionally Vision:..................Frequently Walking:...............Frequently Work Environment Involves no exposure to blood borne pathogens as part of duties Supervision Received Vice President of Operations, Seton Health Plan Supervision Exercised N/A Physical Other NONE Other Functions 1. Performs other duties as assigned.2. Maintains professional growth and development through self-directed learning activities and involvement in professional, civic and community organizations on behalf of Seton as appropriate.3. Represents Seton at various community activities.

Christiana Care Health System is currently seeking a Senior Clinical Researcher to work in our Center for Women´s and Children´s Research. In this role you will conceive, develop and conduct health services clinical research proposals in support of health care quality improvement and patient care. You will write grants and obtain outside funding in support of research protocols. Present research findings, including preparation of research reports and abstracts, dissemination at scientific conferences and publication of manuscripts by peer-reviewed scientific journals.Candidates should have the following qualifications: PhD in Life Sciences or Health Sciences required. Five (5) years of related work experience in women´s and children´s health or OB/GYN research. Experience presenting to scientific and health care forums Experience in writing health services research grants. Prefer funded researchers in women´s health or experience as part of a successfully grant-funded team.An equivalent combination of education and experience may be substituted.

MetroWest Medical Center is the largest health care system between Worcester and Boston, Massachusetts. The 319-bed regional health care system includes Framingham Union Hospital, Leonard Morse Hospital in Natick and the MetroWest Wellness Center.

Manager: Risk ContractsVanguard Health Systems New England Region At least 5 years experience in healthcare, specifically managed care risk sharing and capitation with an emphasis on healthcare contract negotiations, required. Thorough knowledge of standard health care reporting measures such as Member Months, PMPM, days and admits per thousand required. Skilled in financial analysis and financial reconciliation. Prior experience working with all levels of organization including senior management and physicians. Strong negotiating, decision-making and problem-solving skills. Strong project management, quantitative and analytical skills particularly in projecting and monitoring payer net revenue on the basis of existing revenue and cost data. Must have excellent written and oral communication skills. A high level of diplomacy is necessary to anticipate, recognize and deal effectively with issues. Ability to think and plan strategically while managing aggressive deadlines in a fastpaced environment. Advanced user of Microsoft Office products; Excel, Access and PowerPoint. Experience with healthcare applications such as Meditech, Med Assets and/or Crystal Reports a strong plus. Strong knowledge of procedure and diagnostic codes, DRGs, and revenue codes. Must have working knowledge of hospital and physician reimbursement methodologies.

Responsible for identification and resolution of contractual overpayments and underpayments. Compiles reports daily, monthly, and at year-end for Corporate reporting. Maintains all contracts through the computer system. Contacts carriers for additional payments and/or retractions for account resolution.Qualifications Education:• High school diploma or equivalent required. Experience:• Minimum of 3 years Business Office experience and/or equivalent education or job related activities is required. • Knowledge of general office procedures is required. • Ability to communicate effectively including strong interpersonal skills is required. • Strong ability to identify and resolve payment issues. • Must be able to accurately define and understand contracts maintained by the hospital.

Growing healthcare consulting firm seeking Associate: Contract Negotiator

Growing healthcare consulting firm that specializes in management of Ambulatory Surgery Center (ASC) and physician practice managed care contract negotiations is seeking a highly motivated Associate Contract Negotiator who strives to excel with an outstanding work ethic to add to our cohesive team. Clients include ASCs, physician group practices and national ASC management companies. Our clients expect hard work, timely response and high quality service with value added outcomes; these principles define our expectations. Negotiator can expect to work 50+ hours per week to meet the expectations of the position. We are located on Seattle´s eastside.Position Expectations: - Manage numerous contract negotiations simultaneously from inception to completion for clients across the country - Coordinate data and materials needed from client to perform contract evaluation and negotiation - Determine net revenue targets based upon operating cost and sub-specialty casemix - Preparation and submission of written proposals to managed care organizations - Negotiation of reimbursement terms - Continuous and timely communication of status and updates to internal and external clients - Provide financial analyses support for specified projects - Other duties as assignedEXPERIENCE/QUALIFICATIONS: 2-4+ years experience in healthcare business management and/or in healthcare insurance managed care contracting, preferably from the provider side; ASC or surgical practice setting. Bachelors required; MBA, MHA or MPH preferred; may require some travel.Competitive salary and benefits commensurate with applicable education and experienceSerious inquires will be evaluated upon receipt of a letter of interest as well as resume and salary requirements.