MANAGED CARE CONTRACT MANAGER

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Company: H. Lee Moffitt Cancer Center

Location: Tampa, FL 33647

Description:

Managed Care Contract Manager

Position Highlights:
  • The Managed Care Contract Manager is responsible for analyzing, negotiating and maintaining system-wide Managed Care agreements consistent with Moffitt Cancer Center Guidelines.
  • The Managed Care Contract Manager is responsible for managing payer relationships, negotiation of reimbursement rates and contract language, communication and education of contract terms and conditions to appropriate internal parties, researching and resolving managed care related issues, and the analysis of contract performance to expectations.
  • This position will serve as a critical resource in supporting, managing and driving strategic projects; and the development and execution of key business strategies for Moffitt Cancer Center managed and value-based care portfolio.

The Ideal Candidate:
  • The ideal candidate would have a Juris Doctor (JD) with contract management experience.

Responsibilities:
  • Develops, negotiates, administers, and maintains system-wide managed care agreements, including but not limited to, physician, hospital, delegated credentialing and transplant Agreements consistent with Moffitt guidelines and under the direction of the Director of Managed Care.
  • Develops and maintains relationships with internal matrix partners and external payer partners.
  • Develops strategies, contract language and evaluates financial impact of agreements in alignment with Director of Managed Care.
  • Ensuring that Moffitt policies and procedures related to delegated physician credentialing are acceptable to managed care plans. Ensuring that provider status is accurate with all plans.
  • Analyze the managed care environment; monitor and communicate trends in national, regional, and local markets.
  • Responsible for researching, tracking, trending, and resolving managed care related revenue cycle problems between Moffitt and managed care plans. This includes monitoring changes in managed care plan authorization and payment policies and serving as the point person to proactively challenge unfavorable policies with the applicable payer.
  • The Managed Care Contract Manager will work with the Revenue Cycle Departments to resolve systemic managed care payment problems and serve as the point person for enforcing the terms of our managed care contracts.
  • Evaluates possible reimbursement methodologies and business initiatives in view of their relevance and marketability to payers.
  • Analyzes and monitors the financial impact of new and existing managed care agreements in conjunction with the Director of Managed Care.
  • Identifies opportunities to gain efficiencies and greater effectiveness in contracts.
  • Supports Moffitt growth strategies by being a subject matter expert on payment implications for new opportunities.
  • Assists various Moffitt Departments with resolving patient access issues related to patient insurance.
  • Provides support to individual patient Letters of Agreement with non-contracted payers as needed.
  • Serves as the Managed Care Department's liaison within Moffitt and as an organization wide resource for managed care related issues.
  • Resolves issues that arise between Moffitt and managed care organizations.
  • Provides appropriate physician and staff education to support the managed care activities of Moffitt.

Credentials and Experience:
  • Bachelor's Degree - field of study: Healthcare, Finance or related field
  • Minimum five (5) years of progressively challenging experience in managed care contracting, either in a hospital, health system, or managed care organization.

Skills:
  • Skill in composing and editing documents to include contracts, correspondence, and reports.
  • Demonstrated skill in evaluating, monitoring, and improving existing contracts. Proven ability to resolve managed care revenue cycle related issues.
  • Comprehensive knowledge and understanding of managed care principles and practices, experience in fee for service and value based payment models in hospital, physician and transplant provider types.
  • Demonstrated track record of success in negotiating with third parties including preparation and design of the negotiation as well as execution.
  • Proven ability to prepare and present managed care strategies for team, stakeholders and leadership. High proficiencies with Microsoft tools (primarily Word, Excel and Power Point).
  • Demonstrated analytical skills, including financial modeling and reimbursement technologies, proficient in spreadsheet and database programs as well as legal and contractual compliance issues.
  • Excellent written and oral and presentation skills. Excellent interpersonal and problem solving skills.
  • Demonstrated success in building positive and effective relationships with physicians, leadership, and team members. Ability to work effectively in a matrix organizational model. Must be able to work and communicate effectively with all levels of management and staff.
  • Knowledge of both payer and hospital/physician managed care operations
  • Demonstrated knowledge of Federal and State Regulations, including Medicare, Medicaid, and ERISA. Must have significant experience redlining Managed Care Agreements.

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