Manager-Health Plan & Contracting - Revo Health

Revo Health•Bloomington, MN

3d•$100,326 - $152,967•Hybrid

About The Position

Overall responsibility for negotiating and providing oversight of Health Plan contracting for medical practice clients and Ambulatory Surgery Centers (ASC). Primary point of contact for Revenue Cycle management team for contractual questions. Liaison between Revo Health management team and Healthplans for outstanding contractual issues. The incumbent is an integral team member of Revo Health leadership and strategic teams. This is a full-time job working Monday - Friday 7:00 AM - 4:30 PM flexible business hours hybrid out of our Bloomington locations. Revo Health is a professional services company that partners w/multiple healthcare groups to deliver exceptional patient care. This position will be employed through Revo Health, working closely w/Infinite Health Collaborative (i-Health) & its operating divisions.

Requirements

Minimum of three years of advanced experience negotiating and managing commercial, Medicare Advantage, and Medicaid contracts.
Strong knowledge of healthcare reimbursement methodologies, fee schedules, and contract language.
Experience managing health plan contracting and related credentialing interactions.
Experience with contract modeling, reimbursement analysis, claims data analysis, and forecasting contract financial impact.
Advanced Excel skills required
Comply with company policies, procedures, practices, and business ethics guidelines.
Comply with all applicable laws and regulations, (e.g. HIPAA, Stark, OSHA, employment laws, etc.)
Demonstrate prompt and reliable attendance.
Work at an efficient and productive pace, handle interruptions appropriately, and meet deadlines. Prioritize workload effectively.
Communicate respectfully and professionally in face-to-face, phone and email interactions. Apply principles of logical thinking to define problems, establish facts, and draw valid conclusions.

Nice To Haves

Bachelor’s degree preferred.
experience with SQL, Power BI, or Tableau strongly preferred.
Experience in physician groups, MSOs, multi-specialty practices, or integrated healthcare systems preferred.

Responsibilities

Responsible for initiating, negotiating and finalizing contract discussions upon renewal.
Supporting negotiations multi-year (typically 2–3 year) commercial agreements with major payers (BCBS MN, Medica, UHC, HealthPartners); manage a rolling renewal calendar, sending intent-to-negotiate notice ~9 months out and proposals ~6 months out from each renewal date.
Perform data analysis during contract negotiations —analyzing prior-year utilization, billed and paid amounts, denials, and CMS changes — to build payer-specific negotiation models and rate calculators.
Maintain and update professional and ASC rate masters and the associated case-costing/estimate tools, including incorporating CMS quarterly rate updates.
Manage direct-to-employer (D2E) contracting, including bundle/case-rate design and case-costing analysis.
Establish and maintain database of payer newsletters, coverage and reimbursement policies.
Communicate changes in payer coverage and reimbursement policies to clients and Revenue Cycle management team, including a monthly payer-update summary identifying which practices are impacted and how.
Maintain database of payer networks and in/out-of-network status for each network; resolve network- and product-level misclassification issues that surface through prior authorization, care coordination, or claim denials.
Conduct professional, frequent, timely, and appropriate communications with health plans, Revo Health leadership and Revenue Cycle teams.
Actively participate in meetings and other communications processes, including the payer contracting committee, sharing contract status with practices and information timely, accurately and completely with others as needed.
Coordinate with Supply Chain on injectable/infusion drug cost and reimbursement (CMS and health plan rate) analysis to support product decisions.
Ensure compliance with all applicable laws, regulations, etc. (e.g., HIPAA, Stark, employment laws); company policies and procedures; business ethics; etc., including annual charge-master-increase attestations and disclosure-of-ownership filings with each health plan, for both the professional group and each ASC individually.
Evaluate and develop data-driven action plans for efficient, ethical, and productive business practices that lead to patient, employee and physician satisfaction.
Develop short- and long-term training objectives and goals to ensure readiness for regulatory and industry changes.
Other duties as assigned.