Manager Contracting - Plan

Job ID 2012-21352
# Positions 1

Location US-TN-Nashville

Search Category Health Care Operations

Type Regular Full-Time (30+ hours)
Posted Date 12/3/2012

Additional Locations ..
More information about this job:
Summary:

Responsible for developing and expanding AMERIGROUP physician, physician group, IPA, hospital and ancillary networks. Responsible for negotiating reimbursement methodologies and contract language in existing and expansion markets. Ensure that all contracts meet AMERIGROUP standards, including feasibility of administration and reimbursement parameters. Support in the development of external recruitment provider materials.

Responsibilities:

1. Coordinate the management and growth of the hospital relations program or ancillary network that is in line with the health plan’s goals.

2. Coordinate with various departments to effectively implement and manage hospital relations or ancillary network development strategy.

3. Monitor hospital or ancillary network concerns, issues, and business opportunities and work with other functional areas of the Health Plan and Home Office regarding resolutions.

4. Management of Advocacy/Education Process with hospitals and ancillary networks including:

• Financial/Operational analysis regarding contract structure;

• Right-sizing of the ancillary provider network with providers that provide cost effective, quality services to AMERIGROUP members at the least administrative cost that meet contract requirements;

• Develop and implement processes/systems that ensure that hospitals and ancillary providers’ claims are paid accurately, timely, and on first submission;

• Coordination of all processes pertaining to contract implementation/maintenance.

• Coordination of market expansion initiatives;

• Negotiation of financial terms and contract language.

5. Identify quality-based, cost efficient processes and lead efforts to gain acceptance and ensure effective implementation.

6. Serve as key contact for targeted hospitals and other providers to ensure effective communication and response mechanisms.

7. Monitor national trends and local Health Plan market trends relative to Provider contracting, reimbursement, and service, make recommendations to modify current processes and assist to implement changes, when necessary.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:

• Bachelor’s Degree in business administration, healthcare administration, or a related field or equivalent experience.

Years and Type of Experience

Required:

• 5 years experience in a healthcare environment, preferably managed care with at least 1 year of leadership/management experience.

• Specific experience in network development, analysis, and contracting.

• Strong understanding of the healthcare industry, managed care, and provider financing.

• Experience contracting with large, complex provider organizations.

• Documented success in provider contracting, recruitment, retention, and service.

Preferred:

• Knowledge of Medicaid reimbursement and methodologies.

Specific Technical Skills

Required:

• Knowledge of hospital organizational structure including integrated delivery system, PHO’s IPA and Group Practices.

• Computational and analytical skills related to Provider contracting and healthcare cost management.

• Excellent computer skills including MS Office and Access.

Certifications or Licensures

Required:

• Must have a valid driver’s license and access to a motor vehicle.

Other:

Required:

• Excellent verbal and written communication skills.

• Excellent management skills.

• Strong analytical abilities.

• Proven project management skills with a demonstrated ability to manage multiple projects and meet deadlines.

• Appreciation of cultural diversity and sensitivity toward target population.

• Respect for and ability to work well with all levels of the organization and with the Provider Community.

• Ability to establish strategic vision, set expectations and provide clear direction to individuals or departments being managed.

• Understanding of the legal and regulatory environment relative to Provider Relations.

PHYSICAL REQUIREMENTS

• Must be able to operate a computer.

• Must be able to operate a telephone.

• Must be able to travel on common carrier and adhere to AMERIGROUP’s travel policies.

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