Contract Manager - Payer

Option Care Health•Bannockburn, IL

10h•$78,973 - $131,615

About The Position

Manage the negotiation, preparation, financial analysis, business review, and implementation of assigned Managed Care clients, facility compounding agreements for home and alternate site infusion services provided by Option Care. . Responsible for non-strategic managed care plans with less than 250K lives and typically less than $1,000,000 in annual revenues, but may include national network or workers compensation agreements, and non-financial amendments for all managed care clients as assigned by the Contracting Director for the territory. Resolve reimbursement issues arising from contract compliance issues for assigned regions when escalated by Revenue Cycle Management team. Handle day to day issues that may arise out of existing contractual relationships with managed care payers. Additionally, will help support credentialing overflow as a back-up the credentialing coordinator.

Requirements

High school diploma and 5 yrs of experience in managed care account management, contract analysis or administration, or with managed care payers through patient registration or revenue cycle in the health care industry.
Experience in working with managed care clients and familiarity with contract terms and conditions in the ancillary arena.
Experience with analyzing and reporting data in order to identify issues, trends, or exceptions to drive improvement of results and find solutions.
Experience providing customer service to internal and external customers, including meeting quality standards for services.
Experience with Home Infusion or Specialty pharmacy
Experience with CPR+ preferred
Experience using time management skills such as prioritizing/organizing and tracking details and meeting deadlines of multiple projects with varying completion dates.
Intermediate level skill in Microsoft Excel (for example: using SUM function, setting borders, setting column width, inserting charts, using text wrap, sorting, setting headers and footers and/or print scaling).
Intermediate level skill in Microsoft PowerPoint (for example: applying a theme, formatting character spacing, inserting a picture, changing slide layout and theme colors, adding transitions, customizing slide numbers, changing chart style and/or formatting font).
Intermediate level skill in Microsoft Word (for example: inserting headers, page breaks, page numbers and tables and/or adjusting table columns).
Willing to travel up to 25% of the time for business purposes (within state and out of state).

Nice To Haves

Bachelor's degree and 3-5yrs of experience in managed care contract management within the health care industry.

Responsibilities

Manage the negotiation of provider and Facility contracts in accordance with company guidelines for assigned geography for home and alternate site infusion therapy services provided by Option Care
Manage internal implementations of assigned agreements with regional intake, operations, and revenue cycle teams in order to insure success of clean claims payment.
Manage external implementations and foster ongoing relationships with assigned accounts
Subject Matter Expert for CPR+ Shared Contract and Insurance records and work with Contract System Management Analysts providing direction on new contract builds or changes.
Manage communication with assigned accounts as it relates to demographic changes to Option Care Facilities to insure health plan agreements are current in order to facilitate clean claim billing.
Initiate and lead meetings with health plans and corporate teams, including Managed Markets and Contracting leadership, to review provider agreement performance data and scorecards.
Informs contracting leadership of contract risks for assigned third party contracts.
Recommends course of action to reduce/minimize risk to the organization.
Identifies, and assesses impact of potential changes in the industry or changes related to new state or federal legislation.
Resolve reimbursement issues identified by Payer Liaisons that may be related to contract compliance.
Recommends strategies to update and grow a sales representative’s understanding of the scope and intent of assigned managed care or facility contracts.
Attends client meetings where appropriate and in collaboration with assigned managed markets representative.
Maintains successful working relationships with internal departments such as Infusion Operations, Legal, Sales, and any other departments that are involved with or impacted by managed care contracts.
Utilize and participate in deployment of new contract management system
Complete credentialing applications when necessary for new contract access as back up to contract coordinator.
Initiate monthly meetings with assigned Contracting Mentor(s) for development opportunities
Participate in regional meetings as directed by VP, Contracting