Managed Care Contracting Manager

Pennant Services

1d•$95,000 - $105,000•Remote

About The Position

The Managed Care Resource will support Home Health, Hospice, Private Duty, and Senior Living Facility leaders in managed care contracting and revenue enhancement strategies for all healthcare payers. This role will also assist in preparing for changes in the healthcare industry. The Managed Care Resource will negotiate managed care payer contract rates and terms, provide guidance on developing managed care relationships, and ensure the timeliness and appropriateness of negotiated rates. Additionally, the Resource will negotiate contracts for new locations, ensure contracts are updated for new services, manage contract terminations, conduct managed care education sessions, and develop and implement a strategic vision to accelerate results for the supported Operations.

Requirements

Bachelor’s degree in business administration, management, or health care administration preferred.
5+ years of experience in managed care contracting with a managed care payer or provider organization.
Analytically oriented with the ability to communicate complex financial matters concisely and professionally.
Knowledgeable about the managed care environment, including Medicare Advantage, Commercial and Managed Medicaid products (HMO, PPO, EPO, POS and Special Needs Plans), as well as knowledge of Accountable Care Organizations (ACO’s) and value-based purchasing strategies.
Ability to work collaboratively as part of the Managed Care Team.
Knowledge of managed care payer contract language and terms, standard requirements, and negotiated rate methodology to support contract compliance and analysis.
Ability to prioritize, plan, and handle multiple tasks/demands simultaneously.
Strong analytical and problem-solving skills with keen attention to detail and an aptitude for accuracy.
Excellent verbal and written communication skills.
Excellent critical thinking skills.
Ability to maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
Ability to be flexible, adaptable, and work in a rapidly and constantly changing environment.
Knowledge of CPT-4, HCPCS, Revenue and ICD coding.
Strong computer skills (MS Word, MS Outlook & Excel).
Smartsheet knowledge is a plus.

Nice To Haves

Knowledge of Home Health, Hospice, Private Duty, and Assisted Living Facility operations is a plus.

Responsibilities

Engage in complex contract development and negotiation with managed care payors (managed care organizations, ACO’s, health systems, hospitals, physician organizations, third-party administrators) in collaboration with Legal and Finance teams to analyze margins based on costs and rates for existing and newly acquired operations.
Establish, plan, direct, and evaluate the implementation of tactical plans to ensure expansion and support of business operations into managed care relationships, ensuring consistency of contract-related criteria and guidelines to optimize financial performance and minimize risk.
Analyze contract terms and rates, coordinate the submission of amendments, changes in reimbursement, and language changes, and advise operations on the risks and advantages of signing contracts.
Identify, develop, and maintain effective relationships with managed care payors and managed care/health care regulatory agencies.
Provide guidance and training to Field Operations partners to accelerate results.
Monitor industry changes, market trends, and events to proactively identify opportunities to increase and protect managed care revenue, and serve as a subject matter expert on applicable healthcare industry changes.
Coordinate and assist operations with issues such as contract cancellation and denials/appeals.
Communicate effectively at all organizational levels, serving as an internal managed care subject matter expert to Presidents, Executive Directors, and Service Center leadership.
Teach, train, and advise operational leadership on administering managed care contracts by creating and distributing tools, training, and resources for leadership, AR teams, Intake personnel, Case Management, and other Operations or Service Center team members.
Assist the AR team with high-level managed care claims issues and projects to ensure timely collection of monies due.
Serve as the primary liaison for all operations, distributing key contract terms and rates for all new and existing managed care payer contracts.
Travel as required.