Manager - Contract Management and Payer Variance
3 weeks ago
**Are you looking for a career opportunity with growth potential at a healthcare organization that is based on excellence and love?**
ChristianaCare is one of the country's most dynamic healthcare organizations, centered on improving health outcomes, making high-quality care more accessible, and lowering healthcare costs. ChristianaCare includes an extensive network of outpatient services, home health care, urgent care centers, three hospitals (1,299 beds), a free-standing emergency department, a Level I trauma center and a Level III neonatal intensive care unit, a comprehensive stroke center and regional centers of excellence in heart and vascular care, cancer care, and women's health. It also includes the pioneering Gene Editing Institute and was rated by IDG Computerworld as one of the nation's Best Places to Work in IT. ChristianaCare is a nonprofit teaching health system with more than 260 residents and fellows. It is continually ranked by U.S. News & World Report as the Best Hospital. With the unique CareVio data-powered care coordination service and a focus on population health and value-based care, ChristianaCare is shaping the future of health care.
**ChristianaCare Offers**
- Full Medical, Dental, Vision, Life Insurance, etc.
- Two retirement planning offerings, including 403(b) with company contributions
- Generous paid time off with annual roll-over and opportunities to cash out
- 12-week paid parental leave
**About This Position**
ChristianaCare is searching for a Manager of Contract Management and Payor Variance to maintain and oversee day-to-day operations related to management of all managed care payor contract agreements and government reimbursement policies for both the system’s acute and medical group services. This position will also be responsible for the accurate and timely build, as well as maintenance of all contract terms within the patient financial system. The Manager will also provide knowledge of contract language and payor reimbursements to support revenue cycle staff, finance, and others, including vendor partners.
**Principal duties and responsibilities**:
Work collaboratively with payor contracting team, billing managers, payor variance staff, finance, other internal caregivers, and with external staff regarding the identification and timely resolution of contract variance issues, ensuring appropriate payor reimbursement and accuracy of monthly financial net revenue and net accounts receivable reporting.
Manage all additions, revisions, and updates to contract management system for fee schedules, payer policy changes, annual contract renewals, recurring updates to government regulations, pricing corrections, and payor plan mappings for the accurate net down of all claims.
Liaise across revenue cycle to ensure contract terms/reimbursement policies are interpreted and applied accurately and uniformly. Recognize and resolve contract issues and schedule claim repricing as needed, communicating this process with all impacted.
Maintain governmental pricing as per CMS Final Rule/Change Notice releases (Medicare) and Department of Human Services (Medicaid). Ensure accurate governmental pricing through management of facility-specific Medicare and Medicaid factors, DRG version changes, and Medicare physician fee schedules within PFS contract management system.
Work with reporting team to create and develop payor variance reporting to identify discrepancies in payments compared to expected. Perform daily audit to identify any pricing concerns from system related or contract build issues, as well as identification of patterns in payor payment behavior.
Resolve and communicate issues to pertinent parties.
Provide analysis to assist in identifying underpayments to recover lost revenue. Analyze and resolve recurring payment issues and provide communication to help support more favorable payor contract negotiations.
Monitor payer reimbursement policies for changes and regulatory updates. Review communications received from third party payers and share information with impacted personnel. Maintain current knowledge of regulatory requirements related to third party billing & reimbursement.
Field pricing inquiries, originating from billing and follow-up, patient access, revenue integrity, and finance teams. Respond to inquiries regarding third party payer guidelines, CMS policies, and billing department protocols, advising caregivers accordingly.
Perform as main contact for contract pricing inquiries and work related to price estimates tool.
Maintain payor/plan contract list inclusive of effective dates for the ongoing tracking and verification of all payor contracts received and loaded into contract management system. Ensure all health plans on system’s insurance master file have current active contract terms set up in PFS.
Prepare and revise policies and procedures as warranted and conduct in-service/meetings with caregivers.
Coordinate training and education to initiate
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