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Job Standard Detail
Standard 01 Contract Negotiation Support
Provides senior level financial and analytical support for managed care contract negotiations.
Models proposed contract terms and rates and produces accurate results in a timely manner.
Serves as organizational expert for contract modeling.
Collaborates with Director in reviewing and proposing contract language changes that benefit the organization.
Tests all final contracts, utilizing the modeling capabilities of the managed care system and working with software vendor if certain contract terms fail to calculate.
Provides summary of contract terms and interpretation on rate sheets for PFS and Revenue Cycle staff.
Collaborates with Director in creation, dissemination, and education of new contract terms or payor policy changes for hospital staff regarding new contracts or contract amendments.
Responsible for the initiation and completion of credentialing requirements for existing, new, and modified hospital facilities in a timely manner.
Collaborates with payor after contract finalization to confirm agreement with contract load terms.
Standard 02 OnGoing Contract Model Maintenance
Manages routine maintenance for contract models for charge master increases, inflationary rate escalators, regulatory changes, etc. in an accurate and timely manner.
Leads communication and dissemination of contract education for routine contract updates.
Standard 03 Managed Care Reporting
Develops and maintains sophisticated data and trend analysis to provide continuous support for contracting strategy, negotiations, and net revenue budgeting.
Prepares payor report cards, including contract profitability under the direction of the Director.
Standard 04 Managed Care Files
Organizes and maintains managed care files:
Oversees Managed Care Data Analyst in the organization and maintenance of managed care files.
Maintains master lists of payors, contacts, phone numbers, email addresses, etc.
Organizes summaries of contracts and rate sheets for Director.
Standard 05 Managed Care Website
Oversees Managed Care Data Analyst in updating managed care web page on smh.com.
Answers questions regarding website and contracted products for patients and physicians.
Standard 06 Single Case LOA Agreements
Manages various payor requests for LOA's, including setting payment rates at agreed upon organizational strategic rates.
Provides approved documents to PFS and scans documentation into patient's financial record.
Standard 07 Educational Requirements and Competencies
Maintains educational requirements and competency in respective field:
Completes all mandatory education and competency requirements within specified timeframe.
standard 08 Leadership
Provide leadership and supervision for Managed Care Analyst and Managed Care Data Analyst:
Fosters individual growth and establishes a motivational climate through training, counseling, mentoring, and coaching. Prepares key individuals for new roles in the department or organization.
Interviews, participates in the hiring and fair and timely evaluation of employees. Establish employee goals for the benefit of the employees' growth.
Conducts merit evaluations in a timely manner and submits documentation to HR by required deadline.
Text Box: The Managed Care Lead will oversee all daily contracting activities while serving as the contract modeling expert and is responsible for complex accurate modeling of proposed contracts in organization's managed care software, as well as, developing and maintaining sophisticated data and trend analysis in order to provide continuous support for contracting strategy, negotiations, and net revenue budgeting.
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