Contracts Manager

KabaFusion•Columbus, OH

13h•$115,000 - $130,000

About The Position

Responsible for oversight of the managed care contracts through implementation of systems assuring contract compliance, contract data management, and business development as it relates to health plans/payors. Overall field support will include but is not limited to credentialing, contract negotiations, contract interpretations and clarification, contract performance analysis, case management, education, and resources. Understanding claims process and intervention when required as support liaison between KabaFusion and health plan/payors. Basic understanding of current law and regulations, as may be directed by the VP of Managed Care and VP of Regulatory Compliance and Accreditation.

Requirements

Knowledge of managed care contracting billing and negotiations skills necessary
Strong oral and written communication skills
Strong problem-solving skills
Exceptional computer skills in Microsoft Word, Excel, and Outlook
Strong interpersonal skills to interface effectively with all levels of personnel
Ability to maintain confidential company information
Attention to detail
Ability to self-direct work and effectively multi-task
Exemplary follow up and follow through organizational skillset
Must possess at a minimum, bachelor’s degree in business or related experience
Minimum of 7 years of experience in health care industry
At least 3 years’ managed care contracting, billing, and negotiations experience required

Nice To Haves

infusion experience a plus

Responsibilities

Ability to establish and maintain professional business relationships with health plans contract managers
Knowledge and understanding of Division of Financial Responsibility of payors
Knowledge and understanding of various payor product lines
Knowledge of and routine review of contract language, terms, rates, and overall contract mechanics
Assure pharmacies remain fully credentialed with all payors to include management of documents required for credentialing and recredentialing process
Provide assessments and recommendations for contractual operation of managed care patients
Provide training support/resources to the field related to managing/analyzing contract costs
Knowledge of formulary fluidity, high-cost medications /supplies/DME and education/review of pharmacy costs to identify changes, exclusions, and guidance to internal stakeholders
Implement cost reduction measures for the provision of ancillary services of managed care including pricing and rate analysis, formulary monitoring, recommendations, etc.
Assist with creation and implementation of managed care policies and procedures
Update/maintain managed care manuals, fee schedules and contracts
Ensure all documents and contracts meet company standards and are fully executed
Facilitate contract negotiation/renegotiation between health plans, medical groups, IPAs, or other managed care payor sources and KabaFusion’s reimbursement and finance leadership
Other duties as assigned