Description

This is a fully remote position. 

JOB PURPOSE:
Total managed care financial performance of Piedmont Healthcare and The Piedmont Clinic through the development of contract models and analysis of existing and new agreements plus identifying incorrect payer trends while reviewing the performance of current contracts for both the hospitals and the physicians incorporating financial reports and trends in the marketplace. This person is an integral team member and active participant in the strategic development and oversight of all contracting initiatives for current and future Piedmont entities. This position is responsible for responding to all of the managed care contracting analysis needs of Piedmont Healthcare and The Piedmont Clinic and leads analytical resources responsible for the development and financial modeling of contracts, loading and auditing of contract builds in EPSI and the structuring and maintenance of physician fee schedules in EPSI and the CIT.

KEY RESPONSIBILITIES:
1. Serves as a key resource to Piedmont Healthcare and The Piedmont Clinic in the strategic development and oversight of all contracting initiatives for current and future Piedmont entities.
2. Collaborate with Managed Care Department to identify cost savings initiatives and monitor contract performance.
3. Responsible for the management of physician’s fee schedules including uploading of new CMS codes and payer tables.
4. Collaborate with The Piedmont Clinic to identify incorrect payments to physicians and monitor contract performance.
5. Actively participate in contract negotiations with all payers.
6. Respond to the needs of senior leadership regarding network strategies and financial structure of contracts.
7. Prepare and distribute financial reports on a monthly/quarterly basis to senior leadership on the performance of all contracts. Review findings and make key recommendations to senior leadership.
8. Ensure contract compliance from a regulatory basis.
9. Ensure stream lined approach for all contracts from EPSI to EPIC when appropriate.

KNOWLEDGE, SKILLS, ABILITIES
Requires a strong understanding of financial reports.
Ability to interact with senior leadership team and provide recommendation on contract strategies and cost analysis.
Understanding of complex financial reimbursement methodologies used in contracting such as CMS DRG’s, Revenue Codes, APC’s, RBRVS, and ASC Groupers.
Excellent organizations skills and the ability to work under tight deadlines.