Contracting & Payer Relations Specialist

Baptist Health Care•Pensacola, FL

About The Position

The primary purpose of this job is to lead managed care contract negotiations and relations between certain Baptist Health Care entities and the Managed Care Payers/Companies. This individual will lead contract review and conduct analysis, negotiation, implementation, oversight and payer relations for the designated Baptist Health Care entities (i.e. Baptist's Behavioral Medicine Center, Baptist's free standing Ambulatory Surgery Centers).

Requirements

Minimum Education Associates Degree Required
Minimum Work Experience Previous experience in health care business office, contracting or payer organization Required
Required Skills, Knowledge and Abilities Good oral and written communication skills.
Comprehension of managed care principles and practices, with substantial knowledge of business concepts and terminology specific to the health care industry and managed care contract reimbursement methodologies.
Strong knowledge and understanding of patient accounting systems and account management and processes (i.e. billing, coding, collections, rebills, corrected claims).
Ability to understand and effectively use computers to include the use of health care cost accounting systems, contract management systems, PC-based spreadsheets, and PC-based database applications.
Must be able to work independently.
Must be able to establish goals and achieve.
Must be able to work under deadlines and set priorities accordingly.
Strong working knowledge of Managed Care contract terms, particularly reimbursement terms and health care coding principles.
Must be very organized and maintain appropriate system to flag self when contract tables and rules need to be updated or renewed.
Must be comfortable interacting and communicating with individuals at all levels of the Corporation.
Requires a thorough knowledge and understanding of state, federal, and healthcare law, contract law, healthcare finance, and operations as well as key Managed Care mechanisms (i.e. referrals, authorizations, denials, benefit designs, billing/claims, audits, coding, and reimbursement).

Responsibilities

Identifies, analyzes, and manages Managed Care projects, as assigned by Director, such as auditing contract provisions, completing credentialing requests for various BHC entities, interdepartmental work groups, negotiations and maintenance of Managed Care contracts and legal files.
Leads, under the direction of the Corporate Director of Managed Care, contract negotiations for the Behavioral Medicine Center, Baptist Medical Park ASC, Andrews Institute ASC, and Baptist Manor. Assists Corporate Director in contract negotiations for Acute Care Facilities.
Analyzes, researches, evaluates, and redlines Managed Care contracts and communicate with in-house counsel and Corporate Director of Managed Care for instruction and approval.
Understands legal terms and concepts related to contracting; Must be able to research state and federal laws and statute and interpret their meaning and use in Managed Care contracts.
Negotiates Single Case Agreements with Managed Care Payers as may be required .
Evaluates, conducts due diligence, and negotiates growth opportunities with potential Managed Care contracts with Managed Care Organizations & Payers.
Responsible for scheduling, hosting, and conducting Operations Meetings, with the Managed Care Payers, which brings together representatives from the Managed Care Organizations and employees from the BHC Revenue Cycle Depts – Scheduling, Patient Access, Resource Management, Coding, Billing, Collections, Follow Up, Payment Compliance. Sets the agenda, conducts the meeting and provides the follow up notes/minutes.
Responsible for communicating policy and program requirements, of the Managed Care Organizations, to all BHC Operations Group Members
Serves as primary point of contact for internal customer & Entity representatives for questions pertaining to contract requirements.
Identifies potential revenue available in current Managed Care contracts and assists in ensuring that Corporation and Managed Care Organizations are complying with the terms & conditions of the contract.
Effectively manages and organizes data and information pertaining to Managed Care contracts with spreadsheets and composes legal documents and correspondence as required.