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Managed Care Negotiation Specialist
2 months ago
Job Overview
This position plays a crucial role in supporting the Corporate Manager in negotiating terms between payors and all associated healthcare facilities. The responsibilities encompass thorough contract analysis and language evaluation, which includes:
- Review of provider manuals and online resources
- Conducting internal assessments regarding the viability of payor guidelines.
Key Responsibilities
This role is pivotal in managing negotiations and reviewing new service language and rates for goodwill contracts across all healthcare facilities. The process demands:
- Expertise in contract and rate knowledge
- Effective coordination and communication
- Attention to detail and teamwork
- A positive approach to challenging situations.
This position also leads performance improvement teams focused on contract compliance. When new entities are acquired, assistance is provided to the Corporate Manager for seamless managed care transitions, including:
- Development of contract grids
- Internal educational initiatives.
Additionally, this role is responsible for:
- Conducting managed care education sessions, which may require travel
- Overseeing insurance plan education and quarterly training
- Reviewing managed care newsletters for updates.
Training and Education
Acting as a co-trainer for various departments, this position ensures that staff are well-versed in managed care payor processes, including:
- Pre-certification services
- Concurrent review services
- Eligibility verification
- Claims status inquiries.
Moreover, this role manages the online educational resources for all users, ensuring timely updates and accessibility. Responsibilities also include:
- Managing the online contracting database
- Overseeing credentialing and network development issues with managed care payors
- Documenting and communicating denial trends monthly.
Qualifications
A four-year degree in Business is preferred, alongside relevant experience in the healthcare sector. If a degree is not held, candidates should possess:
- 3-5 years of experience in a healthcare facility managing insurance follow-ups or denial trends
- Alternatively, 10 years of experience in healthcare office operations with a solid understanding of insurance processes.
Successful candidates will demonstrate strong problem-solving abilities, effective communication skills, and the capacity to work independently while managing multiple priorities. Proficiency in databases, spreadsheets, and word processing software is essential, as is the ability to maintain confidentiality in all matters related to patients, providers, and payors.
Requirements
No additional requirements beyond those outlined above.
