Phelps Health Job - 41700659 | CareerArc
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Company: Phelps Health
Location: Rolla, MO
Career Level: Mid-Senior Level
Industries: Healthcare, Pharmaceutical, Biotech

Description

General Summary

  • The Managed Care Contract Manager is responsible for the coordination of activities associated with the negotiation and operations of Phelps Health's managed care contracts as well as ensuring reimbursement for services performed are in line with Phelps Health's standards.

Essential Duties and Responsibilities (Up to 8)
  • Coordinates activities associated with the negotiation and operations of Phelps Health's managed care contracts to ensure the best possible outcomes.

  • Evaluates accurately and timely the payments to determine if reimbursements are compliant with the terms of managed care agreements between Phelps Health and insurance companies.

  • Works closely with the Business Intelligence department to run ad hoc reports for the analysis of reimbursement.

  • Analyzes the reimbursement for new services and products and reports these findings to the Executive Director of Revenue Cycle accurately and timely.

  • Negotiates all provisions with managed care companies including language and rate structures.

  • Identifies revenue cycle process improvement opportunities for more efficient and beneficial outcomes.

  • Conducts positive negotiations, ability to compromise, handles conflict, seeks common ground, articulates own and others goals, stays focused on positive outcome.

  • Works with the Credentialing Coordinator to ensure Phelps Health and its providers are credentialed with commercial carriers and helps direct credentialing questions from Phelps Health Medical Group.

  • Works with EnrollU, a team dedicated to the Missouri Marketplace and Insurance Literacy program at the facility, and assists with open Enrollment periods for Medicare Advantage and the Missouri Marketplace. Coordinates with Managers of Phelps Health Medical Group employees who are volunteering with the EnrollU program.

  • Breaks down problems into smaller components, understands underlying issues, can simplify and process complex issues, and understands the difference between critical details and unimportant facts.

  • Has good listening skills, builds strong relationships, is flexible/open-minded, negotiates effectively, solicits performance feedback and handles constructive criticism.

  • Communicates well both verbally and in writing, creates accurate and punctual reports, delivers presentations, shares information and ideas with others, has good listening skills.

  • Manages Client Account negotiations effectively resulting in positive outcomes.

  • Facilitates internal working groups; actively works to bring internal partners together to work on projects associated with Client Accounts.

Job Qualifications
  • Education
    • Bachelor's degree in Accounting, Finance, Business Administration, or other related field is required. Must have a full understanding of issues associated with managed care contracting.


  • Work Experience
    • Five or more years with managed care contracting activities required.

  • Certification/License
    • Not Applicable
Mental/Physical Requirements
  • Requires normal attention, with periods of considerable mental concentration. Work is primarily sedentary with extensive use of a computer.
Working Conditions
  • The standard office conditions.


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