Payor Contract Manager
Corona, CA Corona, CA Full-time Full-time $80,000 - $90,000 a year $80,000 - $90,000 a year 6 days ago 6 days ago 6 days ago Position Summary Responsible for the daily Management and administration of Seven Star Medical Group Inc, and Seven Star Hospital Associates, Inc.
physician contracts with payers, IPAs, MSOs etc.
Negotiates contracts, monitors compliance, identifies areas of opportunity and takes appropriate action.
Essential Functions Responsible for building relationships and representing Seven Star to external healthcare organizations i.
e commercial, Medicare and MediCal managed care plans, state agencies and third-party administrators.
Manages the complete contract negotiation process including contract language review and modifications with California statutes and Seven Star policy, negotiation of reimbursement methodology and financial terms in accordance with Seven Star financial goals and objectives.
Facilitate the approval process of all contract documents from pre- contract through post- contract signature phases.
Negotiates individual Letters of Agreement on behalf of Seven Star with managed care plans for which physicians are not contracted.
Works with KPC analytics to develop and validate financial models needed to assess reimbursement opportunities presented during contract negotiations.
Coordinate and communicate contractual terms and conditions to the billing companies, Seven Star leadership and staff and ensure all are informed of changes in medical policy and billing policies.
Acts a liaison with the billing companies with accounts receivables in monitoring and identifying trends and developing processes for resolution, implementation, and continuous evaluation.
Represents Seven Star at Joint Operation Meetings (JOM's) with contracted payers.
Meet bi- weekly with Seven Star leadership to keep them apprised of ongoing contract discussions with payers.
Manages priorities and ensures deadlines are met.
Other duties as assigned.
Qualifications & Experience Bachelor's degree from an accredited university.
Master's degree preferred.
Minimum 3 years of relevant managed care contracting experience in physician group contracting.
Strong understanding of reimbursement methodologies for hospital-based and outpatient physicians i.
e.
Emergency Medicine, Radiologists, Anesthesiologists, Hospitalists and various other specialty and sub- specialty physicians Strong demonstrated knowledge and understanding of healthcare industry, legal and regulatory requirements.
Excellent contract negotiation skills Excellent interpersonal skills with the ability to forge strong relationships with the payers.
Results driven, able to work independently showing initiative, while seeking guidance when appropriate Ability to multitask while paying attention to detail.
Strong financial and analytical skills.
Experience with Power BI Proficient in MS office software suite (Word, Excel, PowerPoint) Job Type:
Full-time Pay:
$80,000.
00 - $90,000.
00 per year
Benefits:
401(k) Dental insurance Health insurance Life insurance Paid time off Vision insurance Schedule:
8 hour shift Monday to Friday Ability to commute/relocate:
Corona, CA:
Reliably commute or planning to relocate before starting work (Required) Education:
Bachelor's (Required)
Experience:
Managed Care Contracting:
2 years (Preferred) Work Location:
In person.
Estimated Salary: $20 to $28 per hour based on qualifications.
physician contracts with payers, IPAs, MSOs etc.
Negotiates contracts, monitors compliance, identifies areas of opportunity and takes appropriate action.
Essential Functions Responsible for building relationships and representing Seven Star to external healthcare organizations i.
e commercial, Medicare and MediCal managed care plans, state agencies and third-party administrators.
Manages the complete contract negotiation process including contract language review and modifications with California statutes and Seven Star policy, negotiation of reimbursement methodology and financial terms in accordance with Seven Star financial goals and objectives.
Facilitate the approval process of all contract documents from pre- contract through post- contract signature phases.
Negotiates individual Letters of Agreement on behalf of Seven Star with managed care plans for which physicians are not contracted.
Works with KPC analytics to develop and validate financial models needed to assess reimbursement opportunities presented during contract negotiations.
Coordinate and communicate contractual terms and conditions to the billing companies, Seven Star leadership and staff and ensure all are informed of changes in medical policy and billing policies.
Acts a liaison with the billing companies with accounts receivables in monitoring and identifying trends and developing processes for resolution, implementation, and continuous evaluation.
Represents Seven Star at Joint Operation Meetings (JOM's) with contracted payers.
Meet bi- weekly with Seven Star leadership to keep them apprised of ongoing contract discussions with payers.
Manages priorities and ensures deadlines are met.
Other duties as assigned.
Qualifications & Experience Bachelor's degree from an accredited university.
Master's degree preferred.
Minimum 3 years of relevant managed care contracting experience in physician group contracting.
Strong understanding of reimbursement methodologies for hospital-based and outpatient physicians i.
e.
Emergency Medicine, Radiologists, Anesthesiologists, Hospitalists and various other specialty and sub- specialty physicians Strong demonstrated knowledge and understanding of healthcare industry, legal and regulatory requirements.
Excellent contract negotiation skills Excellent interpersonal skills with the ability to forge strong relationships with the payers.
Results driven, able to work independently showing initiative, while seeking guidance when appropriate Ability to multitask while paying attention to detail.
Strong financial and analytical skills.
Experience with Power BI Proficient in MS office software suite (Word, Excel, PowerPoint) Job Type:
Full-time Pay:
$80,000.
00 - $90,000.
00 per year
Benefits:
401(k) Dental insurance Health insurance Life insurance Paid time off Vision insurance Schedule:
8 hour shift Monday to Friday Ability to commute/relocate:
Corona, CA:
Reliably commute or planning to relocate before starting work (Required) Education:
Bachelor's (Required)
Experience:
Managed Care Contracting:
2 years (Preferred) Work Location:
In person.
Estimated Salary: $20 to $28 per hour based on qualifications.
|
|
 | |
