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Contractual arrangements include but are not limited to Medicaid, Commercial, Medicare Advantage, Medicare Accountable Care Organization (ACO) Reach, ACO – Medicaid, Capitation and global shared savings/risk.
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Oversees negotiation of all managed care contracting activities, both fee-for-service (FFS) and value based care (VBC) agreements. Senior Manager Payor Provider Contracting Managed Care@ Chicago, IL (Chicago, IL.
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Under the direction of the SVP, Managed Care and the Director, Managed Care Contracting, the Manager, Managed Care Contracting initiates contract-related financial modeling and analysis and implements contracting initiatives to achieve organization and department goals, and monitors payer activity to ensure their compliance with contractual and regulatory terms and provisions.
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Leading the Contracting & Provider Relations functions for the Southern Bureau health plans and Provider Data Management function for the Managed Care Division. He or she is responsible for projecting and integrating the Mission and Core Values of the organization in the provision of provider data management services to internal and external customers of the Managed Care Division.
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The Chief of Payer Relations and Managed Care will provide overall leadership of UMMC's managed care contracting function to include three hospitals and a multi-specialty faculty practice plan of over 600 providers.
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As a key revenue leader, the CRCO will work closely with business leaders across the organization including, Hospital and Ambulatory clinic senior leadership, Vanderbilt Medical Group and Vanderbilt Integrated Providers leadership, Health Information Technology, Managed Care Contracting, and Access Services, to run the entire revenue cycle function in a highly operational and financially efficient manner.
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Advanced knowledge of commercial and government reimbursement, managed care contracting, fee schedules, revenue cycle management and EMR software systems such as Athena and Epic. Experience with advanced analytics, strong attention to detail, likes to solve problems, and is intellectually curious and an innovator.
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Associate’s degree from an accredited college or a minimum of four years’ experience with managed care contracting or payor relations. Provides backup to Managed Care Provider Enrollment Specialist.
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Five or more years of healthcare leadership and management experience with demonstrated ability in managed care contracting, practice transformation, Value based care performance tracking and systems change.
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Five (5) years of experience working with financial analysis supporting managed care contracting with providers including but not limited to hospitals, professionals ranging from large medical groups to solo practitioners, mental health practitioners, ASCs, skill nursing facilities, renal dialysis facilities, home health and DME. Current working knowledge of all aspects of a provider contract.
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In addition to providing clinical services, the organization embodies superior administrative practice management services, including credentialing, health plan enrollment, managed care contracting, compliance, fee schedule maintenance, billing, payment processing, and collection services.
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Supervises Patient Access Services Health Information Management Patient Financial Services Revenue Integrity Clinical Documentation Improvement Managed Care Population Health/Accountable Care Organization participation Reports To Chief Financial Officer We Offer Competitive salary and benefits package.
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Work Location: Remote Candidates must reside in one of the following states: Florida, Georgia, Virginia, Pennsylvania, Ohio, Tennessee, Alabama, Illinois, Minnesota, Arkansas, Texas, Colorado, California, Washington Hours: 8:30 - 5:00pm Local Time You Will (Responsibilities): The Contract Administrator provides oversight, management, coordination, organization, and communication of payor contracting activities for each of the ABC Medical family of companies.
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QualificationsEducationRequired: Graduate School of PharmacyPreferred: N/AExperienceRequired: 1-2 years of pharmacy experiencePreferred: HMO and 3rd party managed care experienceLicense(s)Required: Intern state license; must obtain Texas Pharmacy License within 90 days of hirePreferred: N/ASpecial SkillsRequired: Able to communicate with other healthcare and company personnel to delegate duties, inform about policies, train, assist with program development and implementation.
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Under the direction of the BMP & BHP CFO, this position will be responsible for a wide variety of duties related to the development, implementation, and ongoing management of the Baystate Health (BH) & Baycare Health Partners (BHP) managed care contracting function.
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