Manager: Physician & Ambulatory Contracting

OverviewThe Manager, Physician & Ambulatory Contracting reports to the Director of Managed Care and is directly responsible for the physician & ambulatory contracting lifecycle. This individual will assess, develop, negotiate, and implement new and evolving contractual relationships in compliance with industry and organizational best practice.Responsibilities: Manager, Physician & Ambulatory Contractor responsibilities include:Managed Care:Manage all aspects of the contracting lifecycle as they pertain to Physician & Ambulatory entitiesEvaluate and negotiate contracts in compliance with company templates, reimbursement structure standards and other key process controlsEnsure a stable and economically viable structure of terms and conditionsAssess and understand the correlation between contract language and payment methodologiesBuild relationships that nurture payor partnerships to seek broader value-based business opportunities to support the physician & ambulatory market strategy.Collaborate with medical economics to best support fee-for-service, value-based & revenue cycle opportunitiesParticipate as the primary managed care advisor in applicable revenue cycle meetings & projects across the physician & ambulatory enterprisePricing and ReportingOversee and ensure the timely and accurate loading of fee schedules within the Epic Resolute Professional Billing applicationConduct analysis to quantify and understand variations in yield and payment accuracyPerform ongoing market analysis using available external data sourcesDevelop service specific and physician level reimbursement analyses and models (involving multiple variables and assumptions) to support a variety of new/revised strategies, approaches, and provisionsProactively and appropriately escalate risks, issues, and decisions.Builds strong cross-functional relationships within the organization including revenue cycle, ACO, clinical operations, and healthcare informatics, in addition to outside business units or affiliated organizations.Has excellent communication skills. Listens well, speaks and writes clearly and concisely. Present in front of a variety of potentially large audiences.Displays model behavior. Engages others to foster further development of AHS core values and mission.Qualifications: Education:Bachelor's degree in Healthcare or Business Administration, Public Health, Mathematics, Healthcare Informatics or similar subjectCandidates with a Master’s in Health or Business Administration preferredRequirements:Three to five years of contracting experience in a complex and fast paced environment. This requirement may be satisfied in lieu of other achievements, accomplishments of experience at the discretion of department leadership.Three years of project management experience or experience and training that includes three years of leading projects related to IT, healthcare, healthcare revenue cycle, healthcare finance, or system implementations.Extensive knowledge of managed care financial metrics (fee-for-service, value-based, P4Q, capitation, etc.)Highly organized with an emphasis on attention to detailKnowledge of physician reimbursement methodologies (CPT code pricing, POS codes, wRVUs, etc.)Extensive experience in Microsoft Excel or other business intelligence software packages (building financial models, pivot tables, complex formulas, macros, VBA, dashboards)Certifications:Epic – Resolute Professional Billing, Contracts Administration: though it is preferred that the candidate have an active certification, others will be considered and required to achieve such certification within 9 months of hire.