Manager Managed Care Contracting and Payor Relations - FT - Day - Managed Care Pennington NJ

Capital Health•Hopewell, NJ

3d•Onsite

About The Position

Capital Health is seeking a Manager of Managed Care Contracting and Payor Relations to support Payor operations, aiming to enhance relationships and improve operational efficiency with Commercial, Medicare, Medicaid, and other insurance programs. This role is responsible for improving reimbursement, network access, and reducing revenue cycle challenges. Capital Health is a leading healthcare provider in the region, known for its commitment to quality patient care and significant investments in its staff and technology. The organization includes two hospitals, an outpatient center, a satellite ED, and an extensive network of primary and specialty care providers. Capital Health Medical Group comprises over 600 physicians and providers serving patients across the region. Recognizing the importance of attracting top talent, Capital Health offers flexible and competitive compensation packages.

Requirements

Bachelor’s degree in Accounting, Business, or related field. A high school diploma or equivalent and additional years of experience may be considered in lieu of a formal Bachelor's degree.
Four years of progressively responsible experience in payor contracting and payor relation activities when accompanied by a Bachelor's degree.
Eight years of progressively responsible experience in payor contracting and payor relation activities when accompanied by a high school diploma or equivalent.
Knowledge of contract management systems.
Strong analytical and interpretive skills.
Excellent organizational, interpersonal, verbal, and written communication skills.
Leadership and problem-solving skills.
Ability to effectively manage multiple projects simultaneously.
Ability to respond quickly in a fast-paced environment.
Familiarity with medical terminology, CPT and ICD-10.

Nice To Haves

Prior management experience is preferred.

Responsibilities

Maintains and enhances relationships with payors to improve the efficiency of the revenue cycle, contracting, and working relations.
Assists in preparing to develop positive relationships and effective communication channels with payors to improve operational relationships and resolve issues, in collaboration with the VP of Payor Relations.
Attends payor meetings to review operational issues.
Maintains and communicates outstanding issues and needs with payors.
Participates in and supports payor contracting negotiation strategies and implementation.
Collaborates with senior leadership to align payer strategies with overall organizational goals.
Provides support and guidance to leadership to monitor and report the financial performance of assigned payor contracts versus expectations to ensure achievement of negotiated rates.
Develops and monitors KPIs to track payor performance.
Assesses payor contracts to identify challenges and opportunities to improve hospital reimbursement and operational efficiency.
Utilizes data and other KPIs to recommend strategies to optimize payor mix and reimbursement rates.
Monitors and manages payor contracts to ensure payor adherence to contracted terms.
Identifies operational challenges with contracts and provides recommendations during contract negotiations.
Monitors and measures payor issues that impact Revenue Cycle, Quality, and Utilization Review.
Escalates, addresses, and resolves issues and disputes with payers in a timely and effective manner.
Monitors changes in market trends, healthcare laws, regulations, and clinical policies that impact payor contracts and relationships, providing recommendations to address such issues.
Communicates and facilitates sessions on key contract and policy changes and shares findings with the organization's leadership.
Takes necessary action based on leadership feedback.
Manages and oversees contract amendments, policy changes, etc., on a timely basis so that Capital Health has an opportunity to appeal the change according to the contract terms.
Notifies payors of charge increases in accordance with contract terms.
Monitors existing agreements to ensure new services/facilities are contracted for in-network participation.
Notifies payors of any new service lines.
Performs other related duties as required or assigned.