WellStar Health System Marietta, GA, USA
Apr 18, 2019Full time
Overview At WellStar we all share common goals. That's what makes us so successful - and such an integral part of our communities. We want the same things, for our organization, for our patients, and for our colleagues. As the most integrated healthcare provider in Georgia, this means we pride ourselves on investing in the communities that we serve. We continue to provide innovative care models, focused on improving quality and access to healthcare. Responsibilities Contract Manager is accountable for negotiating; developing and analyzing Hospital/Physician activities across the enterprise. The Contract Manager will be responsible for managing the facilitation and implementation of each Managed Care agreement through internal and external operational reviews. Maintains and updates the Executive Director on legal and regulatory trends with respect to managed care and the enterprise. Negotiations will typically include both financial and contractual terms. Position will assist in resolving billing or other contractual problems with insurance carriers on behalf of the providers. Facilitates resolution of contractual and operational issues with insurance carriers in order to enhance the managed care contract performance. Contract Manager will assist and work collaboratively with other contract managers in inclusive contract negotiations with insurance carriers. KEY RESPONSIBILITIES: Manages the day-to-day Managed Care operations and contracting activities. Negotiates successful contracts with Managed Care organizations. Analyzes financial component of contracts using internal software system. Networks with payers, providers, and others throughout the region in order to build and maintain market knowledge and market direction. Perform periodic and specific reviews of volume and pricing in an effort to maximize contract performance and continuous improvement. Contacts Managed Care organizations to resolve discrepancies between contracts and payments. Coordinates, facilitates, or assists scheduling JOC meetings between the hospital and Managed Care organization to discuss/resolve contractual and operational issues in order to enhance managed care contract performance. Assist in resolving billing or other contractual problems with payors on behalf of the providers through Provider Relations Department. Reviews all Payors , Monthly, Quarterly or when or how ever posted either via secured payor web portals, payors inter-net sites or any means made available from payor for updates in Policies and Procedures or any changes a Payor would make that may change a WellStar course of business. Determines if change to P & P will have financial adverse impact to WellStar if so communicates with internal and external parties WellStar's objection via written communication to payor. Monitors and updates the Executive Director on political, legal and regulatory trends with respect to managed care and vertical integration. Assist the WellStar acquisition and/or service growth (i.e. facilities, physicians, services, etc.) related organizational activities in order to successful transition/implement all managed care needs. Qualifications Required Minimum Education: A bachelor's degree from a recognized college in healthcare, business, finance, or related field required. Required Minimum Experience: Five years' experience in Managed Care contract negotiations or related activities. Required Minimum Skills: Ability to build relationships with outside vendors. Ability to build strong relationships with internal customers and departments. Strong verbal and written communication skills. Ability to negotiate. Attention to detail and the ability to independently problem solve. Join us for outstanding benefits and development opportunities. We also offer state-of-the-art technology, professional support and advancement, and colleagues that rank amongst the best in the country. The WellStar culture of caring has also been nationally recognized three years in a row by Fortune Magazine as one of the "100 Best Companies to Work For". Step up to your potential. Find out more and apply today. WellStar is an equal opportunity/affirmative action employer. All applicants are considered without regard to race, color, religion, sex, age, national origin, disability, veteran status or any status which is protected by local, state or federal law.