Contract Specialist | Managed Care

Emerus

About The Position

This position will work closely with the Vice President of Managed Care to support the managed care needs of the company and its affiliated joint venture hospitals. Responsibilities include maintaining contract databases, interpreting key contract terms, contract yield modeling, data validation, financial analysis and participation in annual budgeting and month-end close activities. This role also supports Revenue Cycle team members in resolving contract payment disputes and provides assistance to other departments with managed care needs. The successful candidate will be a self-starter who enjoys working in a fast-paced environment, has strong analytical and modeling talents, excellent communication and listening skills, and possesses a high degree of intellectual curiosity with an aptitude to identify areas of opportunity to enhance company revenues.

Requirements

Bachelor’s Degree in Finance, Accounting, Business Administration, or equivalent experience required.
Prefer minimum of 5 years of relevant experience with thorough knowledge of hospital payment methodologies and health plan contracting processes.
Ability to build financial and statistical models, analyze data, and translate analysis into specific, targeted action to drive results.
Expert knowledge of Microsoft Office Suite, specifically Excel, Word, Outlook, and general working knowledge of Internet for business use required. Demonstrated ability to learn and adapt to new software.
Excellent analytical and problem-solving skills
Ability to work in a fast-paced environment
Strong organizational and written/oral communication skills
Ability to work independently and with little supervision
Excellent ability to manage to deadlines
Strong personal initiative to produce quality materials within designated timeframes and simultaneously manage several projects.
Detail focused but can also see the big picture.
Strong familiarity with data analysis and working with complex large volumes of data.
Position requires fluency in English; proficient verbal and written communication skills.

Responsibilities

Managed care liaison for and “subject matter expert” of the company’s joint venture hospital partners, revenue cycle billing and collections team, and finance department leads.
Prepares, compiles and consolidates payor performance metrics data for reporting to organizational leadership.
Maintains a managed care contract database to aid in streamlining collections activity, analysis and the dissemination of contract details and terms.
Supports the company’s revenue cycle team by loading and maintaining up to date contracted payor rates in an insured allowed/payment validation collections module.
Conducts random audits on claim payment activity to ensure payors are honoring the agreed to terms within their managed care agreements.
Provides support for special projects which include but are not limited to, collecting and analyzing claim data needed for contract negotiations, additional service line research and pro forma assistance with new market opportunities.
Develops contract models to evaluate current contract performance yields and new contract proposals.
Partners with revenue cycle team members to identify and establish an inventory of underpaid and overpaid claims so initiatives can be implemented to secure proper payment.
Supports finance team’s annual budget development with managed care assumptions and contract modeling of rate escalators, charge master updates and new contact revenue yields.
Supports the organization’s revenue recognition team as needed with month end close activities by providing managed care’s perspective on key items or initiatives that influence recorded revenues.
Managed care representation in joint venture board meetings as needed.
Performs other financial data gathering and analysis related to internal and external user’s needs and requests.
Researches and responds to inquiries from management.
Provide explanations and recommendations of the subject matter.
Participate in cross-functional business projects, specifically with finance, Operations, Revenue Cycle, and Business Development, and perform ad hoc analysis as required.
Attend staff meetings or other company sponsored or mandated meetings as required.
Perform additional duties as assigned.