Responsible for the administration, data management and general oversight of all payor contracts along with the development of contractual relationships, including the negotiation of terms and maintenance of existing agreements. The Manager of Contracting and Credentialing manages the negotiation or renegotiation of contracts as appropriate and ensures that the terms our favorable to our Urgent Care Centers. This role is responsible for tracking the overall performance of our contracts, collaborating with the Accounts Receivable team and facilitating the resolution of any payment or contract compliance issues. The incumbent identifies new opportunities, develops strategies and responds to requests for proposals or contracts. The incumbent is responsible for ensuring that the contracts are complete, accurate and timely.
Essential Duties and Responsibilities
Leads contract strategy and execution and proactively manages overall contract performance (including any required due diligence, modeling, pay for performance programs).
Leads and coordinates effective execution of new contracting, such as new joint ventures and acquisitions, mass re-contracting or contract integration efforts and direct employer contracting.
Identifies strategic opportunities to collaborate with payors or employers to favorably impact cost of care and reimbursement opportunities
Designs, updates, manages overall payor contracting data, including accountability for defining business processes around contract data, monitoring and maintaining data integrity, and standard reporting as requested
Responsible for assisting with integrity of monthly reports and collaborating with the billing and finance team to define requirements and establish updated templates for contract performance management (underperformance/collection as well as pay for performance).
Manages all contract tables that are placed into the billing systems to effectively report net revenue.
Maintains relationships with payors, internal key departments, and other third parties in order to enhance strategic relationships. This includes setting up quarterly meetings with payers to discuss issues.
Educates revenue team and clinics about contractual obligations or any changes that occur that are contractually, or policy related.
Creates and monitors templates for timely filing risk by payer to be used by the AR managers.
Works with the payers to understand their credentialing requirements. Monitors compliance and timeliness of these submissions by working with the billing managers.
Oversees the credentialing team. Monitors and evaluates employee performance. Holds employees accountable for the attainment of defined goals and objectives. Executes effective performance redirection when needed. Develops employees through coaching, mentoring, and formal/on the job training and development opportunities
Other task as needed
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Requirements Competencies
To perform the job successfully, an individual should demonstrate the following competencies:
Technical Skills - Strives to continuously build knowledge and skills; shares expertise with others.
Customer Service - Responds promptly to customer needs.
Interpersonal Skills - Maintains confidentiality.
Oral Communication - Responds well to questions; participates in meetings.
Written Communication - Presents numerical data effectively.
Teamwork - Balances team and individual responsibilities; contributes to building a positive team spirit.
Quality Management - Demonstrates accuracy and thoroughness.
Business Acumen - Understands business implications of decisions; displays orientation to profitability.
Cost Consciousness - Works within approved budget; develops and implements cost saving measures; contributes to profits and revenue; conserves organizational resources.
Diversity - Promotes a harassment-free environment.
Ethics - Keeps commitments; works with integrity and ethically; upholds organizational values.
Organizational Support - Follows policies and procedures.
Judgment - Exhibits sound and accurate judgment; supports and explains reasoning for decisions; includes appropriate people in decision-making process; makes timely decisions.
Motivation - Sets and achieves challenging goals; demonstrates persistence and overcomes obstacles.
Planning/Organizing - Prioritizes and plans work activities; uses time efficiently; organizes or schedules other people and their tasks.
Professionalism - Reacts well under pressure; accepts responsibility for own actions; follows through on commitments.
Quality - Monitors own work to ensure quality.
Adaptability - Changes approach or method to best fit the situation; able to deal with frequent change, delays, or unexpected events.
Dependability - Keeps commitments; commits to long hours of work when necessary to reach goals.
Education and/or Experience Six plus years' experience in managed care contracting; Bachelors Degree preferred
Language Skills Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.
Reasoning Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
Computer Skills To perform this job successfully, an individual should have intermediate knowledge of Microsoft Office products- Word, PowerPoint. Advanced knowledge in Excel.
Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to sit; use hands to handle or feel; reach with hands and arms and talk or hear. The employee may be required to occasionally lift, push, or pull up to 50 pounds.
Work Environment The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The noise level in the work environment is usually quiet to moderate. The employee may be exposed to infectious or contagious diseases and a variety of electromechanical hazards. The employee may also handle emergency and/or crisis situations.
The above job description is intended to describe the general nature and level of work being performed in the described position. This document is not intended to be an exhaustive list of all position duties and skills required of the individual classified in this position.