Description

This is a fully remote position. 

Manages the day-to-day Managed Care operations and contracting activities across the system. Plans and directs managed care operational practices including analyzing, negotiating and maintaining system wide Managed Care agreements. Monitors and updates Vice President on political, legal and regulatory trends with respect to managed care and vertical integration. Works with and oversees Medical Economics, Decision Support and Revenue Cycle operations to produce reports concerning managed care contract performance and operations. Plans and oversees education for Patient Financial Services (PFS) and applicable Revenue Cycle departments throughout the system in order to educate departments concerning contract terms, language and compliance. Facilitates resolution of contractual and operational issues with payers in order to enhance managed care contract performance. Contributes to the implementation of managed care vision and goals.

KEY RESPONSIBILITIES:
1. Manages the day-to-day Managed Care operations and contracting activities.
2. Negotiates successful contracts with Managed Care organizations.
3. Maintains strong relationships with Managed Care organizations.
4. Analyzes financial component of contracts using Managed Care software system.
5. Networks with payers, providers, brokers, and others throughout the region in order to build and maintain market knowledge and market direction.
6. Works collaboratively with the Revenue Cycle departments to ensure that contracts can be administered from a hospital billing perspective.
7. Works collaboratively with Patient Care Coordination (PCC) to ensure that contracts can be administered from a Utilization Management perspective.
8. Improve overall Managed Care integration into the Piedmont organization through effective communication and implementing strategic initiatives.
9. Perform periodic and specific reviews of volume and pricing in an effort to maximize contract performance and continuous improvement.
10. Contacts Managed Care organizations to resolve discrepancies between contracts and payments.
11. Meets with the PCC Utilization Review staff to identify denials problems and ongoing issues and works to resolve them.
12. Coordinates, facilitates, or assists scheduling operational meetings between the hospital and Managed Care organization to discuss/resolve contractual and operational issues in order to enhance managed care contract performance.
13. Plans and oversees education for Patient Financial Services (PFS) and applicable Revenue Cycle departments throughout the system in order to educate departments concerning contract terms, language and compliance.
14. Gives consideration to the PR (Public Relations) implications when managing contracting and communication of the department.
15. Develops skills and provides focus on the market conditions/changes including but not limited to consumerism, value based healthcare, transparency, risk contracting, etc.
16. Monitors and updates Vice President on political, legal and regulatory trends with respect to managed care and vertical integration.
17. Assist the Piedmont acquisition and/or service growth (i.e. facilities, physicians, services, etc.) related organizational activities in order to successful transition/implement all managed care needs.

KNOWLEDGE, SKILLS, ABILITIES
Extensive knowledge of the Managed Care environment in Georgia or similar market.
Skill and ability to build successful relationships.
Self-motivated with strong organizational and planning skills.
Skill and ability to analyze information using spreadsheet software (i.e. excel), querying software, and/or contract management programs and ability to learn new programs.
Skill and ability to analyze, negotiate and communicate in-person and in writing.