Network Accounts Manager

Ethos Therapy Solutions

8d•Onsite

About The Position

The Managed Care Contract Manager is responsible for overseeing the negotiation, implementation, and management of managed care contracts between the organization and various healthcare payers. This role requires a strong understanding of healthcare reimbursement models, contract negotiation strategies, and excellent communication and analytical skills. The Managed Care Contract Manager works closely with internal stakeholders, including executive leadership, finance, legal, and operations, to ensure favorable contract terms and optimize revenue generation for the organization.

Requirements

Bachelor's degree in healthcare administration, business, finance, or related field (Master's degree preferred).
Minimum of 5 years of experience in managed care contracting, reimbursement, or related roles within the healthcare industry.
Strong knowledge of healthcare reimbursement models, payer contracting strategies, and payment methodologies.
Excellent negotiation skills and ability to influence and build collaborative relationships with external stakeholders.
Proficient in data analysis and financial modeling, with strong attention to detail and accuracy.
Solid understanding of healthcare regulations, compliance requirements, and industry trends.
Excellent communication skills, both written and verbal, with the ability to present complex information to diverse audiences.
Strong organizational skills and ability to manage multiple projects and deadlines effectively.
Proficiency in using contract management software, databases, and Microsoft Office Suite.

Nice To Haves

Master's degree preferred

Responsibilities

Identify, develop and negotiate managed care contracts with healthcare payers, including health insurance companies, managed care organizations, and government payers.
Analyze proposed contract terms and reimbursement rates to ensure alignment with organizational goals and financial objectives.
Collaborate with executive leadership, finance, legal, and operational teams to review and approve contract terms and conditions.
Manage contract renewals, amendments, and terminations in a timely and efficient manner.
Monitor and analyze reimbursement rates, fee schedules, and payment methodologies to identify areas for improvement and revenue optimization.
Conduct financial analyses to assess the impact of proposed contract changes or new reimbursement models.
Evaluate and negotiate reimbursement rate increases or alternative payment models based on market trends and organizational performance.
Establish and maintain strong relationships with payer representatives, including provider relations and contracting teams.
Serve as the primary point of contact for payer inquiries, dispute resolution, and issue escalation.
Collaborate with internal departments to address and resolve contract-related operational and reimbursement issues.
Stay abreast of industry trends, regulatory changes, and government healthcare programs (e.g., Medicare, Medicaid) to ensure compliance with applicable regulations.
Monitor contract compliance, track performance metrics, and address any discrepancies or non-compliant activities.
Implement and maintain processes and systems to ensure accurate contract documentation and tracking.
Utilize contract management software, databases, and analytical tools to track and report on contract performance, reimbursement trends, and financial impact.
Prepare regular reports and presentations for internal stakeholders, including executive leadership, finance, and operational teams.