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Inspire health. Serve with compassion. Be the difference.
Job Summary
Coordinate system-wide hospital and physician services contracting, including but not limited to, strategy formulation, contract terms and contract performance. Coordinate the implementation, presentation and servicing of all contracts for the entire system. Provides system wide managed care education and communication.Remote work can be considered for this position.
Accountabilities
Coordinate the processing of all payer contracts and amendments.\u00A0 Coordinate all the steps required in the development, review and processing of new contracts, contract renewals and contract amendments with payers.\u00A0 Coordinate all required steps for the execution of contracts and amendments and ensure completion or execution of finalized contracts and amendments within specified\u00A0time frames\u00A0or deadlines.\u00A0 Perform detailed review of the business terms in contracts and amendments received from payers, identify unacceptable terms and recommend revised terms that meet the needs of Prisma Health.\u00A0 Negotiate single case agreements when necessary.\u00A040%
Perform detailed analyses of the financial and operational impact of procedural changes implemented by payers.\u00A010%
Develops and maintain contracting decision making and tracking tools.\u00A010%
Develops model contracts or contract language for use in proposing contract or amendments to payers.\u00A0 Establish reporting techniques that will identify areas of concern and prepare recommendations to address any issues.\u00A015%
Provide problem solving support to Prisma Health affiliates and departments.\u00A0 Work closely with payers to ensure that Prisma Health receives all provider manual changes, provider bulletins, benefit plan changes and other payer documents.\u00A0 This position distributes this information throughout\u00A0 Prisma Health in a timely fashion.\u00A0 Conduct pro-active communication, contract compliance, and educational sessions.\u00A0 Develop and maintain effective relationships with payers and internal customers\u00A025%
Supervisory/Management Responsibilities
- This is a non-management job that will report to a supervisor, manager, director or executive.
Minimum Requirements
- Bachelor's Degree.
- 5 years-\u00A0Managed-care experience, preferably in a contracting or provider relations role.
Required Certifications/Registrations/Licenses
- N/A
In Lieu Of The Minimum Requirements Listed Above
- In lieu of manage care experience, fie years experience in healthcare administration, health insurance, or provider contracting.
Other Required Sills and Experience
- Knowledge of the health-insurance industry, specifically managed-care contracting operations and negotiation techniques- Required\u00A0
Work Shift
Day (United States of America)Location
Prisma Health Corporate OfficeFacility
7001 CorporateDepartment
70019069 Managed Care ContractingShare your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.
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Job Summary
Coordinate system-wide hospital and physician services contracting, including but not limited to, strategy formulation, contract terms and contract performance. Coordinate the implementation, presentation and servicing of all contracts for the entire system. Provides system wide managed care education and communication.Remote work can be considered for this position.
Accountabilities
Coordinate the processing of all payer contracts and amendments.\u00A0 Coordinate all the steps required in the development, review and processing of new contracts, contract renewals and contract amendments with payers.\u00A0 Coordinate all required steps for the execution of contracts and amendments and ensure completion or execution of finalized contracts and amendments within specified\u00A0time frames\u00A0or deadlines.\u00A0 Perform detailed review of the business terms in contracts and amendments received from payers, identify unacceptable terms and recommend revised terms that meet the needs of Prisma Health.\u00A0 Negotiate single case agreements when necessary.\u00A040%
Perform detailed analyses of the financial and operational impact of procedural changes implemented by payers.\u00A010%
Develops and maintain contracting decision making and tracking tools.\u00A010%
Develops model contracts or contract language for use in proposing contract or amendments to payers.\u00A0 Establish reporting techniques that will identify areas of concern and prepare recommendations to address any issues.\u00A015%
Provide problem solving support to Prisma Health affiliates and departments.\u00A0 Work closely with payers to ensure that Prisma Health receives all provider manual changes, provider bulletins, benefit plan changes and other payer documents.\u00A0 This position distributes this information throughout\u00A0 Prisma Health in a timely fashion.\u00A0 Conduct pro-active communication, contract compliance, and educational sessions.\u00A0 Develop and maintain effective relationships with payers and internal customers\u00A025%
Supervisory/Management Responsibilities
- This is a non-management job that will report to a supervisor, manager, director or executive.
Minimum Requirements
- Bachelor's Degree.
- 5 years-\u00A0Managed-care experience, preferably in a contracting or provider relations role.
Required Certifications/Registrations/Licenses
- N/A
In Lieu Of The Minimum Requirements Listed Above
- In lieu of manage care experience, fie years experience in healthcare administration, health insurance, or provider contracting.
Other Required Sills and Experience
- Knowledge of the health-insurance industry, specifically managed-care contracting operations and negotiation techniques- Required\u00A0
Work Shift
Day (United States of America)Location
Prisma Health Corporate OfficeFacility
7001 CorporateDepartment
70019069 Managed Care ContractingShare your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.