Revenue Accounting Manager
Equip
MavenSQL
Managed Care AIC Contracts Manager
Option Care Health
full-time
Posted on:
Origin: • 🇺🇸 United States
Visit company websiteSalary
💰 $84,825 - $141,382 per year
Job Level
SeniorLead
About the role
- Job Description Summary: This role is responsible for the more complex and large account negotiations, preparation, financial analysis, business review, and implementation of assigned Managed Care clients, 340B, and Health System Partnership agreements for home and alternate site infusion services provided by Option Care. Responsible for managed care plans with greater than 250K lives that require more complex negotiation and relationship management. Resolve reimbursement issues arising from contract compliance issues for assigned regions when escalated by Revenue Cycle Management team. Manage the negotiation of managed care and health system contracts in accordance with company guidelines for assigned geography for home and alternate site infusion therapy services provided by Option Care Oversee internal implementations of assigned agreements with regional intake, operations, and revenue cycle teams in order to insure success of clean claims payment. Manage external implementations and foster ongoing relationships with assigned accounts Manage communication with assigned accounts as it relates to demographic changes to Option Care Facilities to insure health plan agreements are current in order to facilitate clean claim billing. Initiate and lead meetings with health plans and corporate teams, including Managed Markets and Contracting leadership, to review provider agreement performance data and scorecards. Informs contracting leadership of contract risks for assigned third party contracts. Recommends course of action to reduce/minimize risk to the organization. Identifies, and assesses impact of potential changes in the industry or changes related to new state or federal legislation. Resolve reimbursement issues identified by Payer Liaisons that may be related to contract compliance. Strategize with AVP MMS on plans to update and grow a sales representative’s understanding of the scope and intent of assigned managed care or facility contracts. Attends client meetings where appropriate and in collaboration with assigned managed markets representative. Maintains successful working relationships with internal departments such as Infusion Operations, Legal, Sales, and any other departments that are involved with or impacted by managed care contracts. Complete credentialing applications when necessary for new contract access as back up to contract coordinator. Participate in regional meetings as directed by VP, Contracting
Requirements
- High school diploma and 10yrs of experience in managed care account management or contract analysis and negotiation within the health care industry. Experience with contract negotiations involving financial terms for health care services. Experience in working with managed care clients and familiarity with contract terms and conditions in the ancillary arena. Experience with analyzing and reporting data in order to identify issues, trends, or exceptions to drive improvement of results and find solutions. Experience providing customer service to internal and external customers, including meeting quality standards for services. Experience with Home Infusion or Specialty pharmacy Experience with CPR+ preferred Experience using time management skills such as prioritizing/organizing and tracking details and meeting deadlines of multiple projects with varying completion dates. Intermediate level skill in Microsoft Excel (for example: using SUM function, setting borders, setting column width, inserting charts, using text wrap, sorting, setting headers and footers and/or print scaling). Intermediate level skill in Microsoft PowerPoint (for example: applying a theme, formatting character spacing, inserting a picture, changing slide layout and theme colors, adding transitions, customizing slide numbers, changing chart style and/or formatting font). Intermediate level skill in Microsoft Word (for example: inserting headers, page breaks, page numbers and tables and/or adjusting table columns). Willing to travel up to 25% of the time for business purposes (within state and out of state). Preferred: Bachelor's degree and 5-8yrs of experience in contract management and negotiation within the health care industry.
