Job description

Must-Haves

1 Three (3) to five (5) years experience in managed care contracting either from the provider or the payor side.

2 Contract negotiation experience with insurance payors (commercial payors and government payors)

3 Hospital, Physician Group, Ancillary and Transplant agreement or contracting experience

4 Healthcare reimbursement methodology

5 Strong finance analytical skills

Nice-To-Haves

1 ACO (Accountable Care Organization) contracting experience

2 Strong communication skills and ability to interact with leaders of all levels

3 Intermediate Excel skills (Pivot tables, V Lookup, formulas)

Job Description :

Minimum Qualifications

Education: Bachelors degree in Business, Marketing, Healthcare Administration, or related field preferred. In lieu of degree, relevant work experience will be reviewed.

Licenses/Certifications: (None)

Experience / Knowledge / Skills:

• Three (3) to five (5) years experience in managed care contracting either from the provider or the payor side. In lieu of the Bachelor’s degree referenced above, ten (10) years’ relevant experience is acceptable.
• Strong interpersonal and communication skills
• Excellent presentation skills
• Demonstrates commitment to the Partners-in-Caring process by integrating our culture in all internal and external customer interactions; delivers on our brand promise of “we advance health” through innovation, accountability, empowerment, collaboration, compassion and results while ensuring one Memorial Hermann.

Principal Accountabilities

• Monitors operational compliance of assigned managed care agreements.
• Develops and maintains effective working relationships with insurance company and managed care company personnel responsible for contracting with healthcare providers.
• Negotiates managed care contracts including language, rates, amendments, etc. and monitors financial performance maximizing opportunities for net revenue improvement, volume/growth, and effectiveness of collection efforts.
• Assists in the development and implementation of new reimbursement mechanisms for managed care contracts such as case rates, package or global pricing rates, medical diagnosis categories, capitation, etc.
• Assists in the development and implementation of new types of structural contracting mechanisms such as alliances, subcontracts and contractual joint ventures which will benefit Memorial Hermann in securing managed care contracts.
• Assists Client physicians in their relations with managed care companies and coordinates communications between managed care companies and physicians.
• Obtains managed care agreements and assists Client ancillary companies in their relations with managed care companies.
• Maintains close liaison with payors, Client ancillary providers, joint venture partners, and all supporting hospital system departments (e.g. Patient Business Services, Medical Management, Patient Access, Decision Support, etc.).
• Acts as the Client representative for inquiries from patients, providers, and managed care companies regarding claims issues and special negotiated services.
• Ensures safe care to patients, staffs and visitors; adheres to all policies, procedures, and standards, within budgetary specifications, including time management, supply management, productivity, and accuracy of practice.
• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education, skills competency, supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor, and resource to less experienced staff.
• Other duties as assigned.

Job Types: Full-time, Contract

Salary: $107,700.00 - $140,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift

Supplemental pay types:

• Bonus pay

Ability to commute/relocate:

• Houston, TX 77024: Reliably commute or planning to relocate before starting work (Required)

Application Question(s):

• Screening Questions

1 Describe hospital and physician manage care reimbursement methodologies?
2 Are you willing to adhere to our mandatory COVID vaccination policy?
3 Do you smoke or use any nicotine products in any form?

Education:

• Bachelor's (Required)

Experience:

• managed care contracting either from the provider or: 5 years (Required)
• Contract negotiation with insurance payors: 5 years (Required)
• Healthcare reimbursement methodology: 2 years (Required)
• Strong finance analytical skills: 5 years (Required)

Work Location: One location

Speak with the employer
+91 +91 9035065396

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