Managed Care Contract Manager

1 month ago

Tampa, Florida, United States Moffitt Cancer Center Full time
Job Summary

Moffitt Cancer Center is seeking a highly skilled Managed Care Contract Manager to join our team. As a key member of our Managed Care Department, you will be responsible for analyzing, negotiating, and maintaining system-wide Managed Care agreements consistent with Moffitt Cancer Center Guidelines.

Key Responsibilities:
  • Develops, negotiates, administers, and maintains system-wide managed care agreements, including but not limited to, physician, hospital, delegated credentialing and transplant Agreements consistent with Moffitt guidelines and under the direction of the Director of Managed Care.
  • Develops and maintains relationships with internal matrix partners and external payer partners.
  • Develops strategies, contract language, and evaluates financial impact of agreements in alignment with Director of Managed Care.
  • Ensuring that Moffitt policies and procedures related to delegated physician credentialing are acceptable to managed care plans. Ensuring that provider status is accurate with all plans.
  • Analyze the managed care environment; monitor and communicate trends in national, regional, and local markets.
  • Responsible for researching, tracking, trending, and resolving managed care related revenue cycle problems between Moffitt and managed care plans.
  • Evaluates possible reimbursement methodologies and business initiatives in view of their relevance and marketability to payers.
  • Identifies opportunities to gain efficiencies and greater effectiveness in contracts.
  • Supports Moffitt growth strategies by being a subject matter expert on payment implications for new opportunities.
  • Assists various Moffitt Departments with resolving patient access issues related to patient insurance.
  • Provides support to individual patient Letters of Agreement with non-contracted payers as needed.
Requirements:
  • Bachelor's Degree - field of study: Healthcare, Finance or related field
  • Minimum five (5) years of progressively challenging experience in managed care contracting, either in a hospital, health system, or managed care organization.
  • Skill in composing and editing documents to include contracts, correspondence, and reports.
  • Demonstrated skill in evaluating, monitoring, and improving existing contracts. Proven ability to resolve managed care revenue cycle related issues.
  • Comprehensive knowledge and understanding of managed care principles and practices, experience in fee for service and value-based payment models in hospital, physician, and transplant provider types.
  • Demonstrated track record of success in negotiating with third parties including preparation and design of the negotiation as well as execution.
  • Proven ability to prepare and present managed care strategies for team, stakeholders, and leadership. High proficiencies with Microsoft tools (primarily Word, Excel, and PowerPoint).
  • Demonstrated analytical skills, including financial modeling and reimbursement technologies, proficient in spreadsheet and database programs as well as legal and contractual compliance issues.
  • Excellent written and oral and presentation skills. Excellent interpersonal and problem-solving skills.
  • Demonstrated success in building positive and effective relationships with physicians, leadership, and team members. Ability to work effectively in a matrix organizational model. Must be able to work and communicate effectively with all levels of management and staff.
  • Knowledge of both payer and hospital/physician managed care operations
  • Demonstrated knowledge of Federal and State Regulations, including Medicare, Medicaid, and ERISA. Must have significant experience redlining Managed Care Agreements.
Equal Employment Opportunity

Moffitt Cancer Center is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, or protected veteran or disabled status.

We seek candidates whose skills, and personal and professional experience, have prepared them to contribute to our commitment to diversity and excellence.

Reasonable Accommodation Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job.

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