Managed Care Provider Relations/Contracting Specialist
Employment: Contracting
Type: Full Time
Location: Houston, TX
"You can make a difference in the life of an oncology patient and find your career satisfaction by joining our team of healthcare professionals today."
About the Position
We are seeking a full time Managed Care Contracting Specialist for our Memorial City business office. This position is responsible for assisting in managing development and maintenance of harmonious working relationships with various payers and working with the Revenue Cycle department to ensure accuracy in payer reimbursement.
Shift Schedule:
- Mon - Fri: 8am - 5pm
Benefits:
- Insurances: Life, medical, dental, short term and long term disability
- 401K
- Free parking
- PTO
- Holidays
- Competitive salary
Essential Duties and Responsibilities:
- Learn and become proficient with Oncology Consultants Practice Management System which includes: a. Multiple reimbursement methodologies, payer fee schedules for Professional, Drugs, Radiology, Radiation and other medical services. Conduct contracting business under direct supervision of Director of Contracting & Development (CD).
- Understand and participate in Managed Care Contract Management strategy and support the contracting department to maintain or improve payer composition, reimbursement arrangements, financial impact, and company goals.
- Maintain Contracting Database including paper files for all Contract executed agreements which includes summary, reimbursement and policies of agreement and amendments. This includes maintaining all executed agreements and amendments in original paper and electronic files.
- Learn and proficient as Team Lead for Managed Care Contract Management of Managed Oncology Medical Home agreements. Understanding payment methodologies, Maintain and prepare reports for additional Alternative Payment Models.
- Under supervision of (CD) Director, negotiate and monitor reimbursement arrangements with payers.
- Responsible for maintaining a professional relationship with payers. Ensure effective liaison and rapport is developed and maintained through meetings, correspondence and telephone calls.
- Adept and knowable on payer policies, procedures, fee schedules, quarterly reviews, provider manuals and communicate payers’ websites and payer newsletters regarding specific Managed Care updates or changes. Communication on Managed Care policies directly effecting payment and operations, etc.
- Understand key contracting operating metrics/drivers and measure performance to established contracting metrics. Review and monitor analysis of payer fee schedules reports, dashboards, payer mix, service lines.
- Works with Reimbursement department regarding payer fee schedules methodology and corrections. Facilitates payer analysis on payer trends or inaccurate payment reimbursement based on contractual agreement.
- Coordinate with provider credentialing and compliance on quality assurance programs. Attend Contracting meetings as required.
- Respond to fees or fee schedule inquiries in an effective and timely manner and assist in claims resolution and payment problems. Work closely with Reimbursement, Front Offices, Finance Departments and other divisions within the company on any payer or contracting issue, policies and procedure.
- Organize Contracting Departments annual major payer meetings. Assure staff is kept informed of pertinent changes in payer policies and procedures. Ensure appropriate education/in-servicing is made available to staff. Education may pertain to managed care and areas where pertinent rulings/regulations could affect business.
- Assist marketing efforts by maintenance of existing payer contracts and managed care landscape.
- Ensure our customer services requirements and needs are met at all times by “Doing It Right the First Time.”
- Communicate and interact effectively and professionally with co-workers, management, patients, payers etc.
- Comply with HIPAA, Company Integrity, Compliance Program policies and other applicable company and departmental policies.
- Maintain complete confidentiality of company business.
- Maintain strong communication with Director of Contracting and management regarding development within areas of assigned responsibilities and perform special projects as required or requested.
Additional Duties and Responsibilities:
- Performs other duties as assigned
- Assists with special projects as needed
- Understand and adhere to policies and procedures
- Accept and incorporate changes or new ideas into daily work
- Provide service in a responsive, timely and accurate manner to both clients and follow employees
- Cooperate with team members to accomplish departmental goals
- Interact professionally with clients and fellow employees
Education and/or Experience:
- Experience 3 to 8 years in the Managed Care Payers environment and evaluate Payers’ policies, benefit structures, fee schedules and payment methodologies.
- Prefer experience analyzing and reporting managed data and database to support contracting strategies.
- Bachelor Degree with 2 years’ experience or college courses in Health Care Administration or three to five years of experience in the Healthcare managed care payer industry.
- Proficient with Microsoft Excel; analytical skills with experience creating complex Formulas, Pivot Tables, VLOOKUPS, Macros and Payment Management System reporting software.
- PC skills to include Microsoft, Word and PowerPoint.
- Verbal and written communication skills to interact with all levels of health plan’s personnel.
- Analytical abilities, planning skills and organization skills.
- Experience meeting deadlines with multiple simultaneous projects and work well under pressure.
- Team player/people oriented.
Oncology Consultants is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
About Oncology Consultants
Oncology Consultants has been a premier adult medical oncology & hematology practice in Houston, TX for over 25 years. Our healthcare team is committed to provide state of the art cancer treatment in a caring environment as we continue to expand our oncology services in the metropolitan region..
Medical Center | Memorial City | Sugar Land | Katy | Willowbrook | Southwest Northwest | West Houston
Apply today. Our short application process takes less than 5 minutes with your phone, tablet or computer.