responsibilities
Serves as a representative and challenge count expert (SME) in contracting and reimbursement, imparting insights throughout settlement improvement and negotiations with smaller issuer practices based on claims and marketplace evaluation
supports negotiations, improvement of method, marketplace and provider intelligence, and contract execution for institutional, ancillary and professional carriers, which includes implementation oversight. makes use of claims and code facts to draft and negotiate constant–fee and cost reimbursement care contracts
Evaluates repayment inquiries and develops value–powerful and aggressive repayment techniques, with an emphasis on transitioning from fee-for-carrier to fee–primarily based care
evaluations the performance of company partners primarily based on usage, tendencies, and best metrics to develop price/reimbursement solutions. guarantees that contracts without a doubt define duty for overall performance expenses, and that income or fee incentives offered are tailor-made to the uncertainties worried in agreement performance
Collects, analyzes, and interprets information from internal and outside assets (e.g., fee of care, services, codes, market developments) to ensure accuracy and relevance for community partners
opinions diverse healthcare reimbursement methods and projects economic impacts of issuer contracts inside predetermined targets, summarizing findings the use of charts, graphs, tables or narratives
liable for developing and maintaining relationships with shrunk healthcare companies throughout numerous specialties
Collaborates with inner teams within health offerings to perceive and address gaps in accessibility and network adequacy via recruitment and contracting. guarantees a balanced network composition this is geographically competitive, offers large get right of entry to, and meets value and fashion control targets
monitors and stays present day on political, felony, compliance and regulatory tendencies
ensures contracts observe applicable nation and federal rules and guidelines and actively participates in workgroups or legislative committee meetings
Coordinates administrative duties with inner departments to cope with questions, troubles, and activities related to company contracts
Validates very last agreements and amendments to make certain accuracy and inclusion of all negotiated changes, making sure well timed and correct payments for services rendered

Qualification
settlement Negotiation
Healthcare reimbursement
records analysis
financial evaluation
mission management
relationship building
Microsoft workplace 365
Interpersonal competencies
problem solving
conversation talents
Required
Bachelor’s degree in business management, Healthcare, Public health, Finance or related subject OR in lieu of a Bachelor’s degree, a further 4 years of relevant paintings enjoy is required further to the required paintings revel in
2 years healthcare, business or related discipline
1 yr revel in in contracting, issuer recruitment or company relations
knowledge of a couple of reimbursement methodologies utilized in healthcare company contracting, which include 0.33 birthday celebration fee methodologies, delegated preparations and payor networks (PPO, HMO, fee–based totally contracting, and so on.)
powerful time and challenge management abilties to have the ability to plan and monitor activities to make sure fulfillment of organizational desires
robust interpersonal abilties to correctly interface with all stages of staff, companies, providers, and enterprise–related associates. capability to steer undertaking teams toward aim attainment and paintings independently or as a part of a group
strong analytical, trouble–solving and critical thinking capabilities, with the capacity to apply cause to identify troubles, accumulate facts, set up data, draw legitimate conclusions and expand appropriate pointers to advocate and if vital, negotiate with the outside events
talented with economic analysis/modeling and Microsoft workplace 365 such as word, Excel, Outlook and groups
sturdy negotiation and relationship building capabilities, at the side of an understanding of contractual documents and the ability to efficaciously speak phrases to carriers
should be capable of meet mounted cut-off dates and take care of a couple of customer support demands from internal and outside customers, inside set expectations for provider excellence. have to be capable of efficiently speak and provide tremendous customer support to every internal and outside consumer, including customers who can be traumatic or in any other case difficult
desired
grasp‘s degree in enterprise or Healthcare management
understanding of healthcare or medical health insurance payor industry (Medicare, Medicaid, business, DSNP and different payor applications), inclusive of felony and regulatory requirements
strong knowledge of CPT-four, HCPCS, revenue and ICD coding, medical terminology, claims fee, contract negotiations and hassle resolution

advantages
comprehensive blessings package
various incentive packages/plans
401k contribution packages/plans

📅 Jun 6 Posts (159)