Managed Care Resource

The Pennant Group-posted 3 months ago
$95,000 - $110,000/Yr
Full-time • Mid Level
Nashville, TN
5,001-10,000 employees
Nursing and Residential Care Facilities
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The Managed Care Resource will support our Home Health, Hospice, Private Duty and Senior Living Facility leaders in managed care contracting and revenue enhancement strategies for all healthcare payers as well as assist in the preparation for changes in the healthcare industry. The Managed Care Resource will negotiate managed care payer contract rates and terms and provide guidance with regards to the development of managed care relationships, ensuring timeliness and appropriateness of negotiated rates. Additionally, the Resource will negotiate contracts for new locations, assist with ensuring that contracts are updated for new services, manage contract terminations, conduct managed care education sessions and develop and implement a strategic vision to assist in accelerating the results of the Operations they will support.

  • Engage in complex levels of contract development and negotiation with managed care payors, including but not limited to managed care organizations, ACOs, health systems, hospitals, physician organizations, and third-party administrators.
  • Establish, plan, direct, and evaluate the implementation of tactical plan(s) that will ensure expansion and support of business operations into managed care relationships.
  • Assist in the analysis of contract terms and rates and coordinating the submission of amendments, changes in reimbursement, and language changes.
  • Provide guidance and training when applicable to assist Field Operations partners.
  • Monitor industry changes, market trends, and events to identify opportunities to increase and protect the operations.
  • Coordinate and assist each operation with any issues, such as contract cancellation and denials/appeals.
  • Effectively communicate at all organizational levels and in situations requiring education, consultation, instruction, persuasion, negotiation, and advisement.
  • Teach, train, and advise operational leadership on how to administer their managed care contracts.
  • Assist the AR team with high-level managed care claims issues and projects.
  • Serve as primary liaison for all operations by distributing to operations and the service center all key contract terms and rates for all new and existing managed care payer contracts.
  • Bachelor's degree in business administration, management, or health care administration preferred.
  • 5 + years' experience in managed care contracting with a managed care payer or provider organization.
  • Analytically oriented with the ability to communicate complex financial matters in a concise, professional manner.
  • Knowledgeable about the managed care environment, including Medicare Advantage, Commercial, and Managed Medicaid products.
  • Work collaboratively as part of the Managed Care Team.
  • Knowledge of managed care payer contract language and terms, standard requirements, and negotiated rate methodology.
  • Ability to prioritize, plan, and handle multiple tasks/demands simultaneously.
  • Excellent verbal and written communication skills, as well as excellent critical thinking skills.
  • Maintain confidentiality and comply with the Health Insurance Portability and Accountability Act (HIPAA).
  • Knowledge of Home Health, Hospice, Private Duty, and Assisted Living Facility operations is a plus.
  • 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) with Smartsheet knowledge a plus.
  • Must be able to travel.
  • Compensation: $95,000 - $110,000
  • Hybrid work schedule
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