Mgr Contract

How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives.

Work Shift

Day (United States of America)

Job Summary:

Contract Manager is accountable for negotiating, developing and analyzing Hospital/Physician activities across the enterprise. System overall margin is highly dependent on the performance of managed care contracts. The Contract Manager will have a subset of the overall managed care portfolio up to $2.99 billion. The Contract Manager will be responsible for managing the facilitation and implementation of assigned Managed Care agreements through internal and external operational reviews. Maintains and updates the Director Managed Care on legal and regulatory trends with respect to assigned payors, managed care and the enterprise. Negotiations include both financial and contractual terms. Position will assist in resolving billing or other contractual problems with assigned insurance carriers on behalf of the providers. Facilitates resolution of contractual and operational issues with insurance carriers in order to enhance the managed care contract performance. Contract Manager will assist and work collaboratively with other team members in inclusive contract negotiations with insurance carriers. KEY RESPONSIBILITIES: Manages the day-to-day Managed Care operations and contracting activities. Negotiates successful contracts with Managed Care organizations. Analyzes financial component of contracts using internal software system. Networks with payers, providers, and others throughout the region in order to build and maintain market knowledge and market direction. Perform periodic and specific reviews of volume and pricing in an effort to maximize contract performance and continuous improvement. Contacts Managed Care organizations to resolve discrepancies between contracts and payments. Coordinates, facilitates, or assists scheduling JOC meetings between the hospital and Managed Care organization to discuss/resolve contractual and operational issues in order to enhance managed care contract performance. Assist in resolving billing or other contractual problems with payors on behalf of the providers through Provider Relations Department. Reviews all Payors , Monthly, Quarterly or when or how ever posted either via secured payor web portals, payors internet sites or any means made available from payor for updates in Policies and Procedures or any changes a Payor would make that may change a WellStar course of business. Determines if change to P & P will have financial adverse impact to WellStar if so communicates with internal and external parties WellStar's objection via written communication to payor. Monitors and updates the AVP on political, legal and regulatory trends with respect to managed care and vertical integration. Assist the WellStar acquisition and/or service growth (i.e. facilities, physicians, services, etc.) related organizational activities in order to successful transition/implement all managed care needs.

Core Responsibilities and Essential Functions:

Manage operational aspects of assigned managed care contracts for the System * Research contractual questions and issues providing resolution and/or recommended resolution. * Provide contractual guidance to internal departments. * Manage Ancillary (home health, rehab, ASC, etc.), RX and Behavioral contracts with direction of appropriate departments. * Ensure COLAs and CDM limitations are implemented by payor, rates are correct and communicate to appropriate internal departments. * Lead some negotiations and amendments with certain payors. * Keep abreast of the current happenings with each assigned managed care payor and the managed care market as a whole. *File disputes with payors as necessary to preserve the integrity of negotiated assigned managed care agreements. Assist managed care, Provider Relations and System in issue/problem solving and management of fee schedules. * Conduct financial analysis in support of negotitaions or issue resolution. * Research and manage fee schedule and rate issues and resolutions. * Provide needed information regarding fee schedules and rates to appropriate parties. * Assist in resolution of issues affecting WellStar professional, institutional, and ancillary providers. * Assist and research outstanding contracting issues. Manage Joint operating committees with payors * Prepare and lead meetings with assigned payors. * Compile minutes and manage follow ups with payors and internal departments. * Build relationships with assigned payors. Internal Departments * Communicate any changes in current operations to appropriate departments and management. * Communication will be in a written form to all internal departments. * Will hold meetings with appropriate personnel or department as necessary to communicate changes of payors. * Monitor policy and procedure changes and updates for assigned payors. * Work with appropriate department to determine if change by payor will propose a financial adverse impact to the System. Performs other duties as assigned Complies with all Wellstar Health System policies, standards of work, and code of conduct.

Required Minimum Education:

• Bachelors Business Administration/Management or Bachelors Health Administration or Bachelors Other

Required Minimum License(s) and Certification(s):

All certifications are required upon hire unless otherwise stated.

Additional License(s) and Certification(s):

Required Minimum Experience:

Minimum 5 years experience in Managed Care contract negotiations Required or related activities Required

Required Minimum Skills:

Ability to build relationships with outside vendors, ability to build strong relationships with internal customers and departments, strong verbal and written communication skills, effective negotiation skills, critical thinking skills, attention to detail and the ability to independently problem solve.

Join us and discover the support to do more meaningful workand enjoy a more rewarding life. Connect with the most integrated health system in Georgia, and start a future that gives you more.