PURPOSE AND SCOPE:

Responsible for managing all aspects of the managed care contracted revenue function in the assigned Group(s).  This involves the monitoring, analysis and evaluation of pertinent financial and marketing data, and detailed tracking and follow-up of all contracted revenue.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

• Communicate executed managed care payer agreements to Operations Management and Revenue Cycle teams, ensuring timely and accurate dissemination.
• Ensure compliance with data collection, auditing activities, contract implementation analysis, and new contract performance monitoring.
• Audit billing systems to verify the accuracy of third-party payer contracts, track contract escalators, and notifying payors while updating billing systems accordingly.
• Support budgetary reviews for financial changes to existing and future agreements, with potential responsibility for additional operationally defined markets.
• Lead negotiations with payors under the Managed Care Director's direction, including rate proposals and contract language discussions.
• Drive projects and initiatives that align with Managed Care goals, including internal audits of the contract management system and employee training.
• Perform financial analyses to support contract proposals, terminations, and payor consolidation, including claims data analysis, medication utilization, and rate structure conversion.
• Maintain and produce analytical reports to support managed care efforts, ensuring timely updates to contract management and Revenue Cycle Systems.
• Track and monitor facility changes with payors, assisting the credentialing department in obtaining documentation and maintaining payer demographic verifications.
• Analyze network data for growth, competitive analysis, and mentor staff as applicable.
• Manage the tactical execution of objectives, including cost management, methods, staffing, and providing leadership, coaching, and development plans for direct reports.
• Ensure compliance with company policies, procedures, and relevant laws, establishing internal systems to promote compliance across the team.
• Participate in and lead meetings, problem resolution, and coordination across internal departments and external customers.
• Act as an advisor to subordinates, managing employee performance, and providing technical guidance.
• Assist with various assigned projects and other duties as needed.

Additional responsibilities may include focus on one or more departments or locations.  See applicable addendum for department or location specific functions.

PHYSICAL DEMANDS AND WORKING CONDITIONS:

• The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

SUPERVISION:

• May be responsible for the direct supervision of various levels of department staff.

EDUCATION:

• Bachelor’s Degree required; Advanced Degree desirable

EXPERIENCE AND REQUIRED SKILLS:  

• 6 – 8 years’ related experience; or a Master’s degree with 3 years’ experience; or a PhD without experience; or equivalent directly related work experience.
• 3+ years’ supervisory or project/program management experience preferred.
• Working knowledge of Generally Accepted Accounting Principles (GAAP).
• Strong computer skills with demonstrated proficiency in word processing, spreadsheet, database and email applications.
• Detail oriented with strong analytical and organizational skills.
• Strong oral and written communication skill to effectively communicate with all levels of management.

ACKNOWLEDGEMENT:

I acknowledge that I have read and accepted this job description.  I understand what is expected of me in this position, and I am able to perform the essential functions as outlined with or without reasonable accommodation.  Furthermore, I understand that the duties and responsibilities listed in this job description are intended only as illustrations of the various types of work that may be performed.  The omission of specific statements of duties does not exclude them from the position if the work is similar, related, or a logical assignment to the position.  If I have any questions about duties and responsibilities not specified in this job description that I am asked to perform, I should discuss them with my immediate supervisor or my Human Resources representative.