Job Purpose:
The position leads a team responsible for negotiating managed care contracts for multi-state PET Imaging IDTFs, Radiation Therapy Centers, Comprehensive Cancer Centers, and serves as a liaison between center staff, operations, billing and all payors. In addition, the position is responsible for the administration and maintenance of payor contracts, fee schedules, CMS local coverage decisions, and credentialing.
Essential Functions:
- Responsible for hiring and managing Associates for assigned team. Ensure all staff members receive training, support and development to achieve company and professional goals.
- Maintains staff by orienting, and training employees using the New Team Member Checklist.
- Maintains staff job results by coaching, counseling, and disciplining employees; planning, monitoring, and appraising job results.
- Negotiates managed care contracts for PET Imaging centers, Radiation Therapy centers and Comprehensive Cancer Centers.
- Develops, cultivates, and maintains payor relationships in market specific networks.
- Coordinating contract implementation activities; addressing all payor/billing/claim issues, handling payor concerns.
- Resolves payor issues as necessary.
- Liaison between center staff, operations, billing, appeals and payors.
- Updates commercial and government payor reimbursement fee schedules.
- Point of contact for payors and internal staff with billing and claim issues/questions.
- Researches and disseminates CMS local coverage decisions as soon as posted by Fiscal Intermediaries.
- Tracks and communicates fee schedule updates before they are implemented.
- Ensures managed care contracts are paying according to negotiated reimbursement rates.
- Communicates PET managed care contract terms to ensure internal compliance.
- Analyzes contract performance to ensure external compliance.
- Participate in efforts to increase revenue and improve customer service.
- Regular attendance and punctuality.
- Contributes to team effort by accomplishing related results as needed.
- Ensures that all processing and reporting deadlines are consistently achieved.
- Perform any other functions as required by management.
Qualifications and Education Requirements
- Ability to work a flexible schedule as necessary.
- 7 - 10 years experience in managed care and/or contract negotiations.
- Minimum of 5 years in a responsible position demonstrating management, program development and implementation of managed care and contract related services.
- Bachelor’s degree in related field
Preferred Skills
- Provider managed care contracting experience.
- Ability to analyze data sets and effectively articulate findings.
- Health policy and healthcare operations background.
- Knowledge of basic medical terminology.
- Advanced college degree.
- General knowledge of claims requirements and process.
Required Competencies
Strong leadership and team building skills. Strong Business and Organizational Competence. Exceptional Customer Service Skills. Strong functional Competence. Interpersonal Skill Competency. Stress Tolerance. Initiative. Adaptability. Accountability. Integrity. Self-Confidence. Time Management Skills with an emphasis on multi-tasking.
Physical Demands and work environment
The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Physical demands: Required job duties are essentially sedentary in nature, consisting of occasional walking, standing, lifting and/or carrying ten pounds maximum, seeing, speaking and hearing.
Work environment: Required job duties are normally performed in a climate-controlled office environment.
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