Managed Care Contracting - Maitland

151 Southhall Ln, Maitland, FL 32751, USA Req #978
Tuesday, May 4, 2021

The Manager of Managed Care & Payer Relations supports ADCS’s managed care contracting initiatives and related managed care operations.He/she must work across functional and geographic boundaries to ensure high levels of customer service for both internal and external constituents, and organizational satisfaction relative to the assessment, review, execution and communication of managed care contracts.The Manager may perform other duties as needed or assigned.

ESSENTIAL DUTIES AND RESPONSIBILITIES


  • Develop and maintain working relationships with current and prospective managed care organizations, serving as the primary point of contact for payers’ and ADCS’s operational needs
  • Act as the primary point of contact for inquiries from potential new payers, and contracting requests from internal resources; ensuring that Managed Care and other functional areas have sufficient information to assess and properly prioritize requested new contracts/products
  • Perform initial contract reviews and redline documents to ensure potential contract documents meet ADCS’ Best Practices standards; identify critical deviations from Best Practices and assess the associated risks.
  • Perform analytics within the scope of the Managed Care database, and coordinate with Finance/Ops for analytics needed outside of Managed Care’s database capabilities.
  • Prepare contract summaries and final contract documents (including coordination with Revenue Cycle for all applicable attachments required {i.e., rosters, W-9s, etc.}), consistent with ADCS’ Managed Care Review Criteria for leadership’s final evaluation/execution.
  • Submit executed contracts to payers, and coordinate across functional areas to ensure contracts are loaded properly into multiple systems/databases, and are communicated appropriately.
  • Coordinate internal and external communications and meetings as directed by Managed Care leadership;
  • Manage or participate in special projects as directed by leadership.
  • Ensure all activities are in compliance with rules, regulations, policies, and procedures.
  • Complete other duties as assigned or as necessary.


KNOWLEDGE, SKILLS, AND ABILITIES

  • Communication proficiency
  • Decision-making capabilities
  • Technical capacity
  • Ethical conduct
  • Personal effectiveness/credibility


PROFESSIONALISM / COMMUNICATION

  • Projects a professional manner and image.
  • Adheres to ethical principles; recognizes and respects cultural diversity.
  • Demonstrates initiative and responsibility.
  • Prioritizes and multi-tasks; manages time efficiently


EDUCATION

·Bachelor’s degree or higher.

EXPERIENCE


  • 5 years relevant managed care contracting and operational experience, including reviewing contracts, and payer relations
  • Medical industry-related experience
  • Strong financial analysis and MS Office capabilities
  • Superb project management and organizational capabilities
  • Ability to prioritize and execute tasks based upon the relative financial impact to the organization
  • Strong written communication and presentation skills


Other details

  • Pay Type Salary
  • 151 Southhall Ln, Maitland, FL 32751, USA