Managed Care Contracting Account Manager
|Job Title||Category||Location||Job Type||Posted|
|Managed Care Contracting Account Manager||Accounting/Finance/Billing||Miramar, Florida 33025||Full-Time||05-23-2019|
Why VITAS Healthcare and What Do They Offer Me?
VITAS Healthcare is the nation’s leading provider of end of life care. We provide our employees opportunities for professional growth, advancement and competitive benefits.
Responsible for identifying, developing and establishing strategic relationships with the assigned managed care payers along with managing contract terms and provisions to ensure compliance for business operations and ensure operational processes comply with contractual obligations. Work collaboratively with all Revenue Cycle functional areas to meet stated goals and objectives for days sales outstanding (DSO), bad debt and collection levels.
- Develop and provide oversight to all payer-contracting programs designed to improve operational performance of the agreements including facilitation of meetings between payers and internal VITAS departments
- This individual will have direct interactions with health plan leadership on contract negotiations as well as escalated issues related to managed care operations and contract performance. Strong negotiating experience with health plans is a must.
- Perform review of specific payer agreements to ensure successful renegotiation of contracts and execution of contracts
- Ensuring existing and new contracts conform to all pertinent language requirements from an operational and legal perspective.
- Must be abreast of industry trends related to Medicaid Reform, CMS and Commercial Payer Alternative Payment Models.
Facilitates communication between VITAS Revenue Cycle Management areas in articulating operational contract issues to the Payers and provides the forum to effectively discuss and share information between VITAS and payers.
- Advise the Revenue Cycle management team on emerging trends and methodologies and shifting requirements in managed care contracting, payer relations and legal issues
- Communicate proactively with payers and with National Accounts and Contract Services departments
- Assist with managing the day-to-day operations of the Managed Care Payer Relations team and develops new guidelines and infrastructure to facilitate ongoing compliance with payer requirements and other shifting payer reimbursement trends
- Analyze insurance payment trends by carrier and in aggregate to make recommendations for contract and fee negotiation
- Develop and maintain relationships with assigned third party payers, including but not limited to commercial, Medicaid managed care, ACOs, etc.
- Assist in driving revenue cycle escalation by providing leadership, coordination and subject matter expertise needed to interface with private insurance carries.
- Work effectively with cross company partners to assist with departmental initiatives and day to-day operations.
- Collaborate with Vitas Legal to ensure optimal contract language is obtained and in accordance with UHS Legal and UHS Managed Care guidelines
- Establish and maintain managed care analytics, including fee schedule analysis of assigned payer contracts
- Identify opportunities for renegotiation to optimize reimbursements
- Coordinate with the business offices and contract services to communicate fee schedule updates and changes
- Coordinate with managed care companies, business office, contract services and national accounts to achieve payer onboarding and continued synchronization
- Partner with operations, prior authorization coordinators, business office, and other internal departments as necessary to communicate payer updates and provide assistance to resolve operational issues with payers
- Validate the contract databases to ensure contract data is up to date
- Monthly administration of payer bulletins for “Policy &Procedures” compliance
- Maintain strong relationships and knowledge of the contracting entities within Vitas service area
- Communicate contract provision implications and alternative language
- Maintain a thorough knowledge of reimbursement methodologies, contractual terms, billing and other operational factors needed for contracting and contract implementation
- Maintain a strong awareness of regulatory issues relating to provider and health plan contract matters
- Assist with creating and maintaining updated payor contract matrix
- Understand and communicate contract specific issues to all payors
- Address operational issues and review contracts and terms in order to facilitate implementation
- Serve as a liaison for internal departments and payor contacts to address and settle escalated issues in accordance with escalated parameters and contractual guidelines
- Facilitate monthly/quarterly payor meetings, in-services, education and training to address and resolve issues regarding health plan protocols, procedures, processes and overall effectiveness of the contractual relationship
- Provide support at various levels with external payors and leverage these relationships in order to expeditiously resolve issues impacting reimbursement
- Document terms that are negotiated and changed and disseminate the information to all internal stakeholders
- Conduct claims escalation and settlement processes based on identified escalation process parameters
- Train and educate Revenue Cycle staff and providers on managed care policies and procedures to correct operational deficiencies and ensure compliance and ongoing revenue enhancement
- Act as a resource, to understand the payor and reimbursement relationships that affect our revenue cycle business performance
- Participate as needed in contract negotiations and ensures all contracts are reviewed and audited for accuracy
- Partake in the Contract Review Task Force and works collaboratively with MCOs, Legal, Patient Financial Services, and Information Services, if applicable, to ensure contract implementation process is complete
- Oversee maintenance of managed care contract files and monitors contract compliance as needed for billing compliance, internal audit, and/or special projects
- Perform related duties as required. This position description in no way states or implies that these are the only duties to be performed by the employee occupying this position. Employees will be required to perform any other job-related duties assigned by their supervisor or management.
- Competitive compensation
- Health, dental, vision, life and disability insurance
- Pre-tax healthcare and dependent care flexible spending accounts
- Life insurance
- 401(k) plan with numerous investment options and generous company match
- Cancer and/or critical illness benefit
- Tuition Reimbursement
- Paid Time Off
- Employee Assistance Program
- Legal Insurance
- Roadside Assistance
- Affinity Program
- Three to five years prior relevant experience
- Ability to interpret contract intent and use that knowledge to confirm accuracy of payor contract performance.
- Working knowledge of corporate policies and procedures, coupled with ability to identify required improvement to established policies.
- Good presentation, leadership and team-building skills.
- Proven working knowledge of Medicare/Medicaid reimbursement methods
- Use of independent judgment and creativity applied to resolution of contract issues.
- Ability to work on various assignments simultaneously
- Strong analytical and interpersonal skills within all levels of the organization
- Ability to navigate within automated systems and proficiency in Outlook, Word and Excel
Associate’s degree in accounting, business administration or related field from an accredited college or university or the international equivalent required. Bachelor’s degree preferred.