(Archived) Managed Care Specialist

Position: Managed Care Specialist
Location: Austin, TX
Shift: Direct Hire | Permanent | Full Time

The Managed Care Specialist provides broad support to the managed care team and is familiar with a wide variety of concepts, practices and procedures necessary to meet the goals of the department. In dependently manages the implementation of all contractual changes within various systems used to manage expected contract allowable. Responsible for accurate and timely communication of the financial terms that impact our reimbursement to the appropriate departments of the system. Monitoring the payor policies and protocol changes for financial and operational impacts to the system. Responsible for maintaining key documents and historical accounts of contracts and communications in a repository.

Job Details:

• Oversees and participates in the development, negotiation, implementation, monitoring and management of managed care agreements
• Evaluates and recommends financial parameters and reimbursement methodologies
• Implements new managed care programs. Keeps staff apprised of developments in the managed care marketplace
• Directs and participates in financial analysis of revenue projections based on contractual rates with payers, adverse trends, terms and appropriate recommendations or conclusions
• Analyze and monitor financial aspects of existing managed care contracts. Utilize analysis for feedback on contract renewals, renegotiations or termination. Make recommendations regarding participation or non-participation with new or existing agreements
• Develop and audit payer fee schedules based on negotiated reimbursement rates by contract and/or product line
• Maintain and distribute participation information by payer by network product for all signed contracts, contracts under-negotiation, or plans not being negotiated
• Strategic planning accountability for other reimbursement & profitability endeavors with subcontract arrangements, government programs, pay for performance initiatives
• Perform special projects as requested by the VP of Managed Care
• Liaison with physician practices, hospitals, other affiliated organizations and managed care organizations regarding issues pertaining to managed care
• Initiate contact with MCPs to begin negotiation/re-negotiation process.
• Work with the Analytics Group to establish negotiating position
• Coordinate with Revenue Cycle Group to assure contract compliance and troubleshoot reimbursement issues
• Develop strategies to link payment to performance and quality of the practices

Requirements:

• Bachelor’s Degree: required
• Strong understanding of Managed Care: ACA, ACO, PHO, MSO (HMO, PPO and Government programs): required
• Strong understanding of hospital, physician and ancillary reimbursement methodologies: required
• Contract negotiations experience: required
• Experience with contract modeling software: required
• 5 years of Managed Care or Health plan experience: required
• Strong working knowledge of computer spreadsheet programs and database programs such as Access, CRM Programs: required
• Ability to work independently.
• Strong analytical skills.
• Excellent organizational skills.

For immediate consideration please create a profile and submit your resume through our system. Applications with attached resumes will be given first consideration. Visit us online at [Register to View] to learn more about our company and to view additional openings in your area.

About Us: All Medical Personnel is a national leader in healthcare staffing and recognized by Staffing Industry Analysts (SIA) as one of the nation's largest healthcare staffing firms. Our team of seasoned recruiters are experienced in their ability to recruit, screen and place medical professionals for all types of healthcare settings.