Manager Managed Care Contracting and Payor Relations - FT - Day - Managed Care Pennington NJ

Payor Operations Manager

Support payor operations to enhance relationships and improve operational efficiency with commercial, Medicare, Medicaid, and other insurance programs. Responsible for enhancing reimbursement, network access, and reducing revenue cycle challenges.

Minimum Requirements:

• Education: Bachelor's degree in Accounting, Business or related field. A high school diploma or equivalent and additional years of experience may be considered in lieu of a formal Bachelor's degree.
• Experience: Four years of progressively responsible experience in payor contracting and payor relation activities when accompanied by a Bachelor's degree. Eight years of progressively responsible experience in payor contracting and payor relation activities when accompanied by a high school diploma or equivalent. Prior management experience is preferred.
• Other Credentials: Knowledge and Skills: Knowledge of contract management systems; strong analytical and interpretive skills. Possesses excellent organizational, interpersonal, verbal, and written communication skills, leadership, and problem-solving skills. Ability to effectively manage multiple projects simultaneously and ability to respond quickly in a fast-paced environment. Special Training: Familiarity with medical terminology, CPT, and ICD-10.
• Mental, Behavioral and Emotional Abilities: Usual Work Day: 8 Hours Reporting Relationships: Does this position formally supervise employees? Yes

Essential Functions:

• Maintains and enhances relationships with payors to improve efficiency of revenue cycle, contracting, and working relations.
• In collaboration with VP of Payor Relations, assist in preparation to develop positive relationships and effective communication channels with payors to improve operational relationships and resolve issues.
• Attends payor meetings to review operational issues. Maintain and communicate with payor outstanding issues and needs.
• Participates and supports payor contracting negotiation strategies and implementation.
• Collaborates with senior leadership to align payer strategies with overall organizational goals.
• Provides support and guidance to leadership to monitor and report financial performance of assigned payor contracts versus expectations to assure achievement of negotiated rates.
• Develops and monitors KPIs to monitor payor performance. Assess payor contracts to identify challenges and opportunities to improve hospital reimbursement and operational efficiency.
• Utilizes data and other KPIs to recommend strategies to optimize payor mix and reimbursement rates.
• Monitors and manages payor contracts to assure payor adherence to contracted terms. Identify operational challenges with contracts and provides recommendations during contract negotiations.
• Monitors and measures payor issues that impact revenue cycle, quality, and utilization review.
• Escalate, address, and resolve issues and disputes with payers in a timely and effective manner.
• Monitors changes in market trends, healthcare laws, regulations, and clinical policies that impact payor contracts and relationships. Provide recommendations to address such issues.
• Communicates and facilitates sessions on key contract and policy changes and communicates findings with leadership of the organization. Takes necessary action based on Leadership feedback.
• Manages and oversees the contract amendments, policy changes, etc. on a timely basis so that CH has an opportunity to appeal the change according to the contract terms.
• Notify payors of charge increase in accordance with contract terms.
• Monitors existing agreements to assure new services/facilities are contracted for in-network participation. Notify payors of any new service line.
• Performs other related duties as required or assigned.

Physical Demands and Work Environment:

• Frequent physical demands include:
• Occasional physical demands include: Standing, Walking, Climbing (e.g., stairs or ladders), Carry objects, Push/Pull, Twisting, Bending, Reaching forward, Reaching overhead, Squat/kneel/crawl
• Continuous physical demands include: Keyboard use/repetitive motion, Talk or Hear
• Lifting Floor to Waist 20 lbs. Lifting Waist Level and Above 10 lbs.
• Sensory Requirements include: Accurate Near Vision, Accurate Far Vision, Accurate Color Discrimination, Accurate Depth Perception, Accurate Hearing
• Anticipated Occupational Exposure Risks Include the following: N/A

This position is eligible for the following benefits:

• Medical Plan
• Prescription drug coverage & In-House Employee Pharmacy
• Dental Plan
• Vision Plan
• Flexible Spending Account (FSA)
• Healthcare FSA
• Dependent Care FSA
• Retirement Savings and Investment Plan
• Basic Group Term Life and Accidental Death & Dismemberment (AD&D) Insurance
• Supplemental Group Term Life & Accidental Death & Dismemberment Insurance
• Disability Benefits Long Term Disability (LTD)
• Disability Benefits Short Term Disability (STD)
• Employee Assistance Program
• Commuter Transit
• Commuter Parking
• Supplemental Life Insurance
• Voluntary Life Spouse
• Voluntary Life Employee
• Voluntary Life Child
• Voluntary Legal Services
• Voluntary Accident, Critical Illness and Hospital Indemnity Insurance
• Voluntary Identity Theft Insurance
• Voluntary Pet Insurance
• Paid Time-Off Program