Job Objective :

Under the direction of the Vice President of Revenue Cycle, the Director of Managed Care Contracting will prepare, analyze and assist with negotiations, implementation and monitoring of all managed care agreements, including contracts with health plans (HMOs/PPOs), medical groups, government agencies, and other third-party payers . Additionally, the Director of Managed Care Contracting conducts and coordinates analyses and projects to support the decision making process of the Executive Staff, Board of Directors, and Department Directors. In support of Administration, this position will work under general supervision and will lead the decision support process which supports the hospital's business and strategic planning initiatives for hospital service areas and service lines.

Essential Duties and Responsibilities:

Managed Care Contracts Duties and Responsibilities:

A. Negotiation and review of proposed agreements and contract renewals with HMOs, PPOs, Medical Groups, Government Agencies, and other third-party payers.

2. Ensures proposed contract language is consistent with AVMC Policy and to identify opportunities for improvement.

4. Helps to identify industry trends and changes to AVMC service offerings that may require changes to payment structures (i.e. Add Trauma rates; exclusions for Aphaeresis, etc.)

B. Contract Management System & Data Reporting

1. Responsible for building and maintaining contract management system to calculate contractual allowances and expected reimbursement with support from the Contract Manager and the IT Department if needed.

2. Maintains a shared folder on AVMC Intra-Net with a summary of contract rates and terms.

C. Contract filing and tracking

1. Maintains logs and tracking systems to make sure contracts make it through the approval and signature process in a timely mariner after negotiations.

2. Maintains contract storage system to ensure that all managed care contracts and correspondence are properly filed and protected.

Leadership and Management:

• Develops and implements departmental goals and objectives with input from

Administration.

• Develops and implements departmental policies and procedures that guide and support the provision of services.

• Interacts with all customers to ensure prompt and accurate communication as needed to provide the service expected and to meet the goals of the service.

• Evaluates problems, and develops and implements solutions.
• Develops new ideas and/or systems with innovation and creativity.
• Challenges the status quo in looking for more efficient practices.
• Leads by example and serves as a professional role model.
• Updates employees on present as well as future changes.
• Actively listens and tries to understand before responding.
• Shapes an environment that is psychologically safe, encouraging and non-judgmental.
• Supports, encourages and contributes to the professional growth of all department staff members.

• Understands, teaches and implements elements of empowerment and team building.

Non-Essential Duties:

· Other duties as assigned, within skill sets and abilities

Knowledge, Skills and Abilities:

Knowledge

• Knowledge of Health Information Systems (3M or equivalent or Clinical Information

Systems) is a plus.

• Working knowledge of Medicare and Medi-Cal reimbursement
• Expert knowledge of Commercial, HMO, PPO, and Workers' Compensation reimbursement

· Expert knowledge of Managed Care contract language and interpretation

Skills

• Proficient in Microsoft (Word, Access, PowerPoint, SQL, Visio, Outlook, etc.)

and Lotus.

• Advanced Excel Skills
• Knowledge of basic personal computers

Abilities

• Is proficient in Department of Health Care Access and Information (HCAI), formerly known as, OSHPD data analysis

• Ability to review all billing transactions for accuracy, discrepancies, and appropriate charges

Education and Experience:

Education

• Bachelor’s Degree in business management/administration or healthcare related field is required
• MBA/MHA is preferred

Experience

• 5-years of experience in managed care contract negotiations
• Experience with modeling proposed changes to existing managed care contracts
  

Required Licensure and/or Certifications:

• None

Key Physical Requirements and Working Conditions:

• Normal office hours: 8:00 a.m. to 5:00 p.m., Monday through Friday.
• Working for extended periods of time looking at a computer screen.

· Work requires frequent visits to conference/office locations within the hospital

· Must be able to used standard office equipment, sit and walk to meetings.

A detailed description of the physical requirements of this job is maintained in the Employee Health Department .

NOTE: THE ABOVE STATEMENTS ARE INTENDED TO DESCRIBE THE GENERAL NATURE AND LEVEL OF WORK PERFORMED BY PEOPLE ASSIGNED TO THIS JOB. THIS DOCUMENT IS NOT INTENDED TO BE AN EXHAUSTIVE LIST OF ALL RESPONSIBILITIES, SKILLS, AND WORKING CONDITIONS FOR THE PERSONNEL SO CLASSIFIED.

Education:

• Bachelor’s Degree in business management/administration or healthcare related field is required