Managed Care Contract Specialist
Location: Madison Wisconsin
Description: TotalMed Staffing is in need of Managed Care Contract Specialist right now, this occupation will be placed in Wisconsin. More complete informations about this occupation opportunity please read the description below. Seeking a Contract Specialist for a Direct Hire position with a healthcare facility in the Madison, WI. This is a direct hire opportunity with a well respected organizatio! n. Target salary range is $70k - $90k (will vary by experience).
The Senior Contracting Specialist assists the health plan in ensuring a competitive provider network by securing needed provider agreements, negotiating to the desired contractual and reimbursement terms and prioritizes network contracting needs based upon provider network adequacy and the organization's business needs.
This position is responsible for managing successful contracting negotiations and relationships for large scope and complex providers, including: hospital systems, large physician groups, larger Physician Hospital Organizations (PHOs), tertiary and quaternary referral provider agreements for higher-end specialty care not available within organization's provider-sponsored networks, full ancillary services providers, and provider sponsor facilities/ employed physician groups/ other provider sponsor provider entities, e.g. durable medical equipment, skilled nursing facilities, home he! alth & hospice agencies.
The Senior Contracting Speci! alist supports organizations provider contracting strategies both for initial and new provider network needs. This position ensures that provider contracts assigned are negotiated within targeted reimbursement terms and pursuant to administrative terms that maximize the companys claims processing system automation capabilities and efficiencies.
The Senior Contracting Specialist role is further responsible for drafting of unique contract language and customized provider reimbursement terms, which requires thorough understanding and ability to model fixed reimbursements following Centers for Medicare and Medicaid payment models, e.g. RBRVS Relative Value Units, Ambulatory Surgery Groups and per diem payments and conversion factors, as well as industry-standard managed care terms and conditions.
This position maintains and distributes contract information to contract inquiries received from organizations hospital systems, large physician groups, PHOs and orga! nization's provider-sponsored networks to include all ancillary, durable medical equipment, home health , skilled nursing facilities and hospice agencies, both provider-sponsored and others, in addition to other internal organization operations departments so that any required contractual interpretation or input is provided.
Provides internal departments with the operations interpretation of provider contracts is a key responsibility of this position.
This position responds to contract inquiries received from providers and represents the contract and the provider with internal operations departments so that any required contractual interpretation or input is provided.
REQUIRED SKILLS FOR: MANAGED CARE CONTRACT SPECIALIST
Bachelor degree in Business, Healthcare Management/Administration or health care field, Communications or 8+ years equivalent work experience within a Managed Care, Insurance or Provider Setting.
5+ years ! of Managed Care or Insurance contracting experience.
Comprehen! sive understanding and ability to model fixed reimbursements following Centers for Medicare and Medicaid payment models, e.g. DRG-based inpatient, Ambulatory Surgical Grouper outpatient, fixed rate fee schedules for outpatient laboratory, radiology, cardiac testing and injectibles reimbursement, RBRVS Relative Value Units professional services terms, and per diem payments, as well as industry-standard managed care terms and conditions.
Thorough knowledge of managed care products, e.g. HMO, Point-of-Service, PPO, and provider network administration, insurance operations and/or business law.
Excellent problem solving and organizational skills.
Excellent verbal and written communication skills with the ability to negotiate effectively.
Demonstrated ability to negotiate effectively and independently within established authority levels, under circumstances which can be conflict-laden.
Able to handle multiple tasks simultaneously, meet! time sensitive deadlines and organize workload with general supervision.
Extensive knowledge of commercial insurance/Administrative Services Only, Medicare and Medicaid benefits and contracts terms, and reimbursement structures.
Expertise working with Microsoft Office Products, including Word, PowerPoint and Excel.
Ability to work independently to achieve identified goals.
Ability to work in a fast-paced, multi-tasking environment.
OTHER
A valid drivers license and personal, reliable vehicle for work-related travel to provider facilities.
Overnight travel may be required from time-to-time as determined by business goals and expansion efforts.
The standard business hours for this role are 8:00 am-4:30 pm. Extended hours may be required during peak times
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If you were eligible to this occupation, please email us your resume, with salary requirements and a resume to TotalMed Staffing! .
If you interested on this occupation just click on the Apply button, you will be redirected to the official website
This occupation starts available on: Sun, 10 Nov 2013 10:38:19 GMT