Associate Contract Manager, Payer Contracting

3 days ago

Brookline MA United States Dana-Farber Cancer Institute Full time
The Associate Contract Manager is responsible for providing contracting, analytic, and operations support on a variety of departmental and administrative activities. The role will support the Payor Contracting & Performance team by assisting with the management of health insurance contracts as well as maintenance of various administrative contract tools that help support revenue cycle and access management operations. -The Associate Contract Manager will manage and finalize single case letters of agreement with both government and commercial health plan payors for patients undergoing cancer care. - The role will assist in the preparation and presentation of contract summaries highlighting critical aspects of reimbursement, patient access, billing requirements and any other special provisions. - -The Associate Contract Manager must be capable of managing multiple priorities under tight deadlines and thrive collaborating with team members and others at varying levels of the organization. The position will require researching and presenting internally on a variety of topics including, but not limited to, new product offerings, plan policies and guidelines, and other critical matters as needed to support the goals of the department and the organization. Located in Boston and the surrounding communities, Dana-Farber Cancer Institute is a leader in life changing breakthroughs in cancer research and patient care. We are united in our mission of conquering cancer, HIV/AIDS and related diseases. We strive to create an inclusive, diverse, and equitable environment where we provide compassionate and comprehensive care to patients of all backgrounds, and design programs to promote public health particularly among high-risk and underserved populations. We conduct groundbreaking research that advances treatment, we educate tomorrow's physician/researchers, and we work with amazing partners, including other Harvard Medical School-affiliated hospitals.Payor Contracting
  • Collaborate with Director and other senior department members in the creation and maintenance of contract management tools that track critical contract terms and facilitate revenue cycle operations and patient access management.
  • Assist with processing and management of single case letters of agreement.
  • Maintain records for correspondence and documentation for established contracts and those in progress.
  • Acquire detailed understanding of key contract terms between DFCI and payors.
  • Act as a liaison with health insurance payors on topics including, but not limited to, health plan networks, billing and payment policies, reimbursement issues, and other ad hoc items.
  • Manage resolution of assigned contract implementation and/or operational issues.
  • Develop and maintain relationships with payor contacts and internal constituents.
  • Participate in payor contract operations meetings.Managed Care Operations
    • Lead payor contact for single case agreements and payor contracts as assigned by Director - responsibilities will include contract development, finalization and implementation, provider relations, provider education, reporting requirements and credentialing.
    • Research, recommend, and implement process improvements to existing payor management data and tools.
    • Prepare new and amended contract summaries for presentation to finance, revenue cycle, and access management teams.
    • Participate in staff education efforts on commercial and government (both state and federal) health care marketplace change.
    • Foster positive relationships with new and existing clinical cancer care affiliates.Contract surveillance and monitoring
      • Assist in the development and management of tools to assist cross-institutional revenue cycle teams in prospectively managing complex payor policies and rules.
      • Perform research to review various health plan contract provisions and provider manuals for rules and guidelines that relate to DFCI core services and report summary findings to Director and/or other senior team members.
      • Prepare contract documents, amendments, termination letters, and/or assist with payment disputes, as
      • Partner with staff across departments to track operational business/contract "pain "
      • Maintain payer files and databases that support contract compliance with payors.Research/Special Projects
        • Compile reports on topics related to individual health plans' policies and procedures, manuals, new
        • product designs and other relevant payer specific information.
        • Complete research and present findings on assigned topics related to other commercial and government health insurance programs.
        • Assist Director and other senior team members with the development of any ad hoc presentation materials. -
          • Bachelor's degree in health care, business, finance or related field required.
          • 3 years of contracting experience required; experience in a general healthcare setting preferred.
          • 1-3 years of contracting experience in healthcare strongly preferred.
          • Knowledge of clinical delivery systems, third party reimbursement, commercial payment methodologies, and acute interest in evolving health reform preferred.KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED:
            • Intermediate/Advanced proficiency in Microsoft business applications, e., PowerPoint, Excel, Word.
            • Familiarity with Massachusetts health insurance market.
            • Superior interpersonal and communication skills with the ability to cooperate and collaborate with multiple, cross-functional teams.
            • Strong decision-making, critical thinking and problem-solving skills.
            • Exceptional organizational skills and superior attention to detail with demonstrated ability to effectively manage multiple priorities under tight deadlines.
            • Adept at collaborating with team members and leadership to drive successful contracting outcomes.
            • Ability to work in a fast-paced, rapidly changing matrixed environment and cross collaborate with others at varying reporting levels within and external to the organization.
            • Capability to work independently and meet deadlines with general supervision.At Dana-Farber Cancer Institute, we work every day to create an innovative, caring, and inclusive environment where every patient, family, and staff member feels they belong. - As relentless as we are in our mission to reduce the burden of cancer for all, we are equally committed to diversifying our faculty and staff. - Cancer knows no boundaries and when it comes to hiring the most dedicated and diverse professionals, neither do we. If working in this kind of organization inspires you, we encourage you to apply. -Dana-Farber Cancer Institute is an equal opportunity employer and affirms the right of every qualified applicant to receive consideration for employment without regard to race, color, religion, sex, gender identity or expression, national origin, sexual orientation, genetic information, disability, age, ancestry, military service, protected veteran status, or other characteristics protected by law. -EEOC Poster

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