OverviewCommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community.ResponsibilitiesThis is a remote position within the National team that supports the South region with a focus on KY. Strongly prefer someone located within the South Region.The Region Contract Manager for Payer Strategy & Relationships (PSR) assists PSR leaders in the development, implementation and management of PSR system standards for contracting and payer relations. Accountabilities include: ensuring that managed care contracts are correctly negotiated and implemented for operational compliance across the division; implementing departmental policies and procedures that focus on maintaining positive working relationships with Payers and Providers; coordinating directly with internal & external stakeholders to ensure contract compliance on a regional and market level.Essential Key Job Responsibilities
Negotiates contracts with Payers on behalf of Providers (including hospitals, physicians, ambulatory surgery centers and other affiliated providers as assigned) and with Providers on behalf of capitated hospitals. Contracts may include letters of agreement and single case agreements at the direction of senior leadership.
Maintains supportive relationships with key departments that support the division in order to quickly resolve contract-related issues.
Ensures complex payer information and reports are analyzed and summarized to provide timely operational and contracting recommendations for key internal leaders. Research contract and regulations to assist with claim payment issues and/or credentialing issues with payers.
Drafts and summarizes content for official correspondence as issues arise with policy updates or compliance with agreements.
Assists with updating project plan documents and communications plans.
Monitors contract terms, termination dates, and rate update deadlines to assure proper and timely notification is achieved in compliance with project plan and strategy.
Assists in developing tools/updates for communicating and operationalizing contract terms, amendments, and policy terms.
Adheres to all established contracting guidelines. Contracting accountability for negotiation support include hospital, physician, and ancillary services.
As applicable, ensure standardized monthly, quarterly and ad-hoc meetings with Managed Care Organizations occur and issues are resolved in a timely fashion.
Participate in joint operating committee meetings with payers, medical groups or providers as needed
#LI-CSHQualificationsRequired Education and Experience
Bachelor’s Degree – equivalent experience and/or education in Finance and health care may be considered in lieu of degree
Minimum of three (3) years of experience in managed care contracting
Fee-For-Service and Value Based Arrangements experience highly desired
Required Knowledge, Skills and Abilities
Knowledge and experience in reimbursement, the financial aspects of contracting and managed care operations
Managed Care contract negotiation skills and relationship management skills
Effective project planning skills
Excellent written and verbal communication skills
Working knowledge of state and federal programs such as Medicaid and Medicare
Working knowledge of various reimbursement methodologies including DRG’s, per diems, RVU’s
Ability to effectively work within a highly matrix-oriented organization
Pay Range$38.81 - $56.28 /hourWe are an equal opportunity/affirmative action employer.