Managed Care Contract Specialist - CBO Managed Care - ProMedica System

Working with the Director and AVP of Managed Care, this position is responsible for developing and implementing managed care strategies and relationships designed to maintain and grow the ProMedica Health System (PHS), which comprises a network of hospitals, primary care and specialty providers, and a clinically integrated network (ProMedica Health Network).  Objective is to provide best in class managed care contracting, analytics, education, and service.

ACCOUNTABILITIES 
1. Operate as team lead responsible for all behavioral health and vision agreements and managing the relationships with those managed care payors and behavioral health agencies
2. Responsible for managing payer issues that are escalated to Managed Care and making sure each are resolved. This includes items like billing issues, contract loading issues, credentialing issues and inpatient and post acute prior authorization issues. This person will be part of monthly payer calls to oversee the conversations between the payers and our billing staff to make sure these issues are beign resolved timely and appropriately.
3. Lead interdisciplinary team of key stakeholders involved in analyzing relevant data to identify industry changes and policies made to managed care contracts and reimbursement
4. Negotiate and manage administration of all value-based agreements

5. Work collaboratively with hospital, ProMedica Physician Group (PPG) and other PHS business teams, especially as it relates to billing, credentialing and other administrative functions, with goal to deliver cross-functional outcomes
6. Support Managed Care team with matters relating to external providers, plan sponsors, regulatory agencies, managed care payors, business development, and the community
 

REQUIRED QUALIFICATIONS
Education: Graduate of an accredited college or university in Health Care Administration, Business, Finance or similar field.
Skills: Experience negotiating managed care contracts in a health system, consulting firm, or with a managed care payor preferred.  Knowledge of Ohio and Michigan insurance payers required. Knowledge of basic Microsoft Office tools required.  Ability to work individually and in a team setting.  Motivated to achieve results. Strong communication skills and the ability to lead meetings are necessary.
Years of Experience: 1-2 in Managed Care or Billing

PREFERRED QUALIFICATIONS
Education: Master’s degree 
Skills: Understanding of PHS information systems preferred.  Advanced knowledge of Microsoft Office tools
Years of Experience: 3 in Managed Care or Billing

ADDITIONAL EXPERIENCE
Contract negotiating experience with managed care payors.

ProMedica is a mission-based, not-for-profit integrated healthcare organization headquartered in Toledo, Ohio.  For more information, please visit www.promedica.org/about-promedica

Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex/gender (including pregnancy), sexual orientation, gender identity or gender expression, age, physical or mental disability, military or protected veteran status, citizenship, familial or marital status, genetics, or any other legally protected category. In compliance with the Americans with Disabilities Act Amendment Act (ADAAA), if you have a disability and would like to request an accommodation in order to apply for a job with ProMedica, please contact employment@promedica.org

Equal Opportunity Employer/Drug-Free Workplace