Reimbursement Contract Manager

Soleo Health Inc•Frisco, TX

80d•Remote

About The Position

The Reimbursement Contracts Manager is responsible for supporting the intake and reimbursement teams in the area of commercial contracting and government programs. This position involves research of payor contracts and other published information, publication and maintenance of resource documents and communication with provider relation teams to resolve contract and/or regulation non-compliance. Responsibilities include: Review payor contracts for intake and reimbursement contract terms (e.g., timely filing, clean claim payment terms) and for comprehensive fee provisions/fee schedules common billable services (e.g., per diems, nursing and drugs) Work with Managed Markets team to address any missing or unfavorable intake and reimbursement contract terms Provide comprehensive analyses of missing or unfavorable intake and reimbursement contract terms to VP of Reimbursement and CFO or their respective designees Provide payor education to intake and reimbursement teams, including reimbursement trends and policies Create, maintain, and manage all Intake and Reimbursement contract resource documents. Cultivate and maintain effective working relationship with contracted and non-contracted insurance Provider Relations personnel Work with Provider Relations personnel to address intake and reimbursement trending issues (e.g., claim denials, non-compliance with contract terms) Identify opportunities for cost savings and cash collections through payer reimbursement analysis/trends Be a contributor to internal and external departmental conversations regarding payers, contracts and industry knowledge Completes all necessary managerial tasks for direct reports including hiring, training, addressing performance issues, developing team goals and objectives, performance reviews, conflict resolution, and strategic planning Other duties as assigned by manager

Requirements

Bachelor's Degree or a minimum of 5 years of Reimbursement/Account Management experience with injectable or infused drugs, or medical device products that require reimbursement support. High school diploma (or equivalent) required
Significant specialty pharmacy or home infusion experience required
Demonstrated proficiency in working on Medicare, Medicaid, or Managed Care reimbursement issues at the provider and payer levels
Possess exceptional verbal and written communication skills, along with problem solving and organizational skills
Strong business, analytical, administrative, and team building skills are essential

Responsibilities

Review payor contracts for intake and reimbursement contract terms (e.g., timely filing, clean claim payment terms) and for comprehensive fee provisions/fee schedules common billable services (e.g., per diems, nursing and drugs)
Work with Managed Markets team to address any missing or unfavorable intake and reimbursement contract terms
Provide comprehensive analyses of missing or unfavorable intake and reimbursement contract terms to VP of Reimbursement and CFO or their respective designees
Provide payor education to intake and reimbursement teams, including reimbursement trends and policies
Create, maintain, and manage all Intake and Reimbursement contract resource documents. Cultivate and maintain effective working relationship with contracted and non-contracted insurance Provider Relations personnel
Work with Provider Relations personnel to address intake and reimbursement trending issues (e.g., claim denials, non-compliance with contract terms)
Identify opportunities for cost savings and cash collections through payer reimbursement analysis/trends
Be a contributor to internal and external departmental conversations regarding payers, contracts and industry knowledge
Completes all necessary managerial tasks for direct reports including hiring, training, addressing performance issues, developing team goals and objectives, performance reviews, conflict resolution, and strategic planning
Other duties as assigned by manager