Contract Sourcing Specialist - Beacon Health System

Reports to the Executive Director. Responsible for assisting the Managed Care Executive Team in negotiating, maintenance, problem resolution and internal coordination of assigned managed care contracts and proposals for Beacon Health System. Works with the Managed Care Executive team to manage the contract process for Beacon Health System. Acts as a service representative for internal clients and payors, scheduling in-services as needed and works to provide information to Beacon Entities to enable them to operationalize their managed care agreements. Responsible for maintaining contracting files. Supports the management team by providing input into the strategic planning process. Responsible to assist with the Beacon ACO as directed.

Responsibilities

Maintains coordination for Managed Care contracts with involved entities and is responsible for customer service representation to all clients by:

• Notifying appropriate entities of all new contracts and any alterations of current contracts.
• Developing and circulating all quarterly reports.
• Working on the development of managed care contracts and proposed protocols with the assistance of management.
• Handling contract negotiation/renewal processes and/or undertaking these tasks as directed and/or necessary with the assistance of management.
• Works with the Managed Care enrollment team to coordinate the completion of the enrollment paperwork of new payors.
• Serving as a liaison with attorney regarding contract language.
• Attend all applicable meetings necessary to obtain approval on proposed agreements by Beacon Entities.

Coordinates Managed Care activities, as well as serving as a liaison to the Hospital Finance Department, by:

• Maintaining current contracts, credentialing information and roster of clients.
• Notifying appropriate entities of new payor groups.
• Coordinating activities and resolving problems of key internal functions such as Accounting, Billing, Collections and Registration.
• Assisting management with new product design.
• Assisting in the development and maintenance of policies and procedures to most effectively manage and monitor Managed Care activities.
• Coordinate with Executive Director for evaluation and modeling of proposed financial terms, making recommendations based upon the financial analysis performed to prepare for counter proposals to payers.
• Present new contracts and or revised fee proposals to the appropriate Beacon Entity for approval.

Serves as Managed Care System Administrator by:

• Maintaining current knowledge base on benefit and network designs to act as service representative for internal and external contacts and maintaining payor database.
• Coordinating and conducting training as needed for administrative staff.
• Maintaining information on the intranet site.
• Conduct and/or arrange regular education trainings for contracted managed care companies to ensure managed care provider tools and resources are known.
• Assess performance of contracted agreements for each Beacon Entity and communicate those findings to management to compose contracting strategies and goals yearly

Qualifications

• The knowledge, skills and abilities as indicated below are normally acquired through the successful completion of a Bachelor's Degree in Business, Economics, Marketing or a related field.
• A minimum of three years of managed care and group insurance experience, through which a background in Medicaid, Medicare and physician contracting was gained, is required. Preference given to applicants that have experience in contracting for providers/facilities in the State of Michigan.
• Requires an in-depth knowledge and understanding of employee benefit products/plans, including health/medical, dental and workers compensation, case processing (proposal, renewal, plan design, billing, claims, etc.) and the regulatory provisions of the Health Insurance Portability & Accountability Act of 1996 (HIPAA).
• Requires well-developed knowledge and understanding of PHO, HMO, PPO and POS healthcare delivery systems.
• Requires strong skills in organization, time management, research and analysis.
• Requires an in-depth understanding of contractual language, computer systems, accounting and finance.

​​​​​​​Working Conditions

• Works in an office environment.
• May be required to vary hours and days, and work on holidays, etc., depending upon the needs of the department.
• Physical Demands
• Requires the physical ability and stamina to perform the essential functions of the position.

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