Facilities Contract Manager
Location: Alameda California
Description: Alameda Alliance for Health is hiring Facilities Contract Manager right now, this career will be placed in California. For complete informations about this career opportunity kindly see the descriptions. Under general supervision and direction from the Manager, Contract Operations, the Facilities Contract Manager is responsible for managing the implementation of hospital and ancillary faci! lities contract rates and terms. This position coordinates with General Counsel, Medical Services, Provider Services, Health Plan Services, Government Relations and Compliance, Claims, and Finance departments to develop and maintain a contracted hospital and ancillary facilities network that meets the needs of the Plan and products and supports internal data input, communication of contract terms, and an up-to-date provider directory, as well as ongoing monitoring for contractual compliance.
The Facilities Contract Manager develops the provider network yielding a geographically competitive, broad access, stable network that achieves objectives for unit cost performance and trend management, and produces an affordable and predictable product for customers and business partners. This position evaluates and negotiates contracts in compliance with company contract templates, unit cost targets, reimbursement structure standards, and other key process controls.
Re! sponsibilities:
Principal responsibilities include:!
- Establish and maintain strong business relationships with hospital systems and ancillary facility providers and ensure appropriate network composition.
- Execute and administer contracts and letters of agreement that offer access to quality healthcare services, adhere to regulatory requirements, protect the assets of the Alliance, and make sound managed care, business and operational sense.
- Coordinate with Business Operations, Claims, Medical Services, Health Plan Services, and Provider Services departments to ensure that contract terms are in line with practice patterns and operational.
- To ensure the integrity and accuracy of all hospital and ancillary facility provider demographic and contracting information in supporting systems (i.e., main transaction system and/or databases, electronic and paper files).
- Ensure continuity of provider information between systems through audits and reports.
- Proper notification a! nd updates of contracted hospital and ancillary facility providers and contractual terms to all Alliance staff (especially Medical and Health Plan Services).
- Network assessment and development including reporting on how many providers (i.e., by specialty, by contract, by city, etc.) are in the network and identify gaps.
- Coordinate with Business Operations to ensure that all new providers are loaded timely, terminated providers are terminated correctly, that practice information and provider demographics are correct and that reimbursement contracts are correct in the main transaction system.
- Create hospital and ancillary provider directories for all lines of business.
- Respond to provider contract questions from both external and internal clients.
- Regulatory reporting in regards to the hospital and ancillary facility provider network.
- Coordinate with Internal and external clients to generate Letters of Agreement for non-co! ntracted providers.
- AB 1455 contract compliance notifications.!
- Systematic archival and retrieval of contracts and information â€" this includes, but is not limited to, ensuring that the paper contract filing system is complete, imaging of contract signature pages and reimbursement schedules are easily referenced and available on shared drives (new project), and all filing is up to date.
- Maintain historical files/tables that document provider reimbursement histories.
- Contribute articles on relevant contracting issues for the Provider Bulletin.
- Conduct ad hoc reporting of network.
- Complete special projects and other duties as assigned.
- Analysis of contract terms and compliance.
- Ensure that contracts reflect regulatory requirements.
- Responsible for ensuring accurate and timely input of contract pricing into Health Suite (or other claims program).
- Develop, implement, and maintain audit policies and procedures to ! ensure the integrity of data entered into the various hospital and ancillary facilities provider databases.
- Consult with managers, IT, and employee users.
- Communicate effectively and efficiently internally and externally.
- Writing, report preparation, administration, and data analysis.
- Develop oral presentations.
- Lead and participate in internal and external committees and meetings.
- Comply with the organization’s Code of Conduct, all regulatory and contractual requirements, organizational policies, procedures, and internal controls.
- Constant and close visual work at desk or computer.
- Constant sitting and working at desk.
- Constant data entry using keyboard and/or mouse.
- Frequent use of telephone headset.
- Frequent verbal and written communication with staff and other business associates by telephone, correspondence, or in person.
- Frequent lifting of folders and other objects weighing between 0 ! and 30 lbs.
- Frequent walking and standing.
- Occasional driving of automobiles.
MINIMUM QUALIFICATIONS
EDUCATION OR TRAINING EQUIVALENT TO:
- Bachelor’s Degree or equivalent experience.
- Three years of work experience within the health care/managed care environment.
- Two years of previous experience in managed care contracting.
- Experience negotiating hospital and skilled nursing facility contracts is preferred.
- Familiarity and knowledge of provider payment methodologies.
- Knowledge of Medicare or Medicaid reimbursement methodologies. Knowledge of Resource Based Relative Value System (RBRVS).
- Ability to make thoughtful decisions and exercise sound judgment.
- Strong interpersonal and problem so! lving skills with orientation to detail.
- Ability to work effectively in a multidisciplinary team approach to assist management.
- Ability to motivate and supervise.
- Experience in use of IBM based computer software: Microsoft Word, Microsoft Access/SQL Microsoft Excel, Microsoft PowerPoint, and Microsoft Outlook.
- Knowledge of organizational health plan functions desired, but not required.
- Ability to communicate effectively, both verbally and in writing.
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If you were eligible to this career, please email us your resume, with salary requirements and a resume to Alameda Alliance for Health.
If you interested on this career just click on the Apply button, you will be redirected to the official website
This career starts available on: Sun, 25 Aug 2013 02:53:37 GMT