The VP of Managed Care Contracting is responsible for direct revenue contract management including negotiation, analysis interpretation, implementation, maintenance of the contracts performance, and payer relations. The position is also responsible for coordination and communication between managed care and other key stakeholder departments and Leadership. Responsible for developing new and existing relationships with third party payers to ensure competitive reimbursement rates and contract language attainable through the revenue cycle operations for the evaluation, negotiation, and implementation of payer contracts to ensure best possible hospital and physician reimbursement methodologies. Models appropriate behavior as exemplified in MLH Mission, Vision and Values.
Key Job Responsibilities:
Development of new and existing relationships with third party payers to ensure competitive reimbursement rates and contract language attainable through the revenue cycle operations.
Evaluate, negotiate, and secure financially and administratively favorable managed care contracts with new and existing health plans/managed care organizations. Develop and support managed care strategies and initiatives for MLH to adapt to ongoing healthcare payment reforms and evolving payment methodologies.
Define contract negotiation objectives in coordination with the Executive and Senior Leadership team and manage and support the maintenance of a detailed utilization database.
Monitor and plan for contract renewals, budget increases, and ensure that all renewals are completed. Works with the CFOs for budgeting increases annually.
Serves as a resource for information about contract terms, managed care projects, payer processes, revenue cycle inquiries, and to facilitate the resolution of complex issues that arise.
Responsible for communications with third party payers regarding updates to the health system including changes in locations, additions, or other material system changes that impact payer contracts and reimbursement.
Coordinate preparation and completion of due diligence process for new entity acquisitions. Prepare documents for payers reporting changes in facilities or physician group information.
Manage all components of the contract negotiation process for directly negotiated contracts. Assist JV partners with payer negotiations on behalf of JV facilities and physician entities.
Identify and implement contracting opportunities for revenue improvement and administrative efficiency and ensure that contract renewals are modeled for financial impact.
Identify opportunities with payers to acquire premier provider designations for hospital entities and physicians. Seek opportunities for new patient volumes through payer initiatives.
Participate in activities which result in improved contract performance, which include performing payer analysis and communicating with all Revenue Cycle teams.
Participate and/or facilitate regular meetings with third-party payers to ensure continuing contract performance, identify payer issues affecting payment or operations, discuss/ resolve claim issues resulting from contract interpretation and/or language, and to assist hospital staff in developing relationships with payers.
Supervision Provided by this Position:
Supervises directly or indirectly the associates reporting to Corporate Manage Care and/or Revenue Management.
About Methodist LeBonheur Healthcare
MLH has been caring for patients and families regardless of ability to pay for more than 100 years. Guided by roots in the United Methodist Church and founded in 1918 to help meet the growing need for quality health care in the greater Memphis area, MLH has grown from one hospital into a comprehensive healthcare system with 13,000 associates, supporting six hospitals, ambulatory surgery centers, outpatient facilities, hospice residence and physician practices serving communities across the Mid-South. From transplants and advanced heart procedures to expert neurology services and compassionate cancer care, MLH offers clinical expertise with a focus on improving every life it touches.
This outstanding opportunity is based in Memphis, Tennessee. Boasting one of the South's largest medical centers, Memphis blends a friendly community, a thriving and growing downtown, and a low cost of living. With many theaters, museums, parks, malls, and sporting events, there's always something to do in Memphis. Good food, nice weather, and great people make Memphis a wonderful place to live.
Strong technical knowledge of managed care contracting, payer policies, hospital and physician reimbursement methodologies, and state and regulatory requirements.
Track record of successful negotiations between major payor organizations and healthcare providers.
Strong organizational and interpersonal skills, with ability to communicate effectively, both orally and in writing.
Ability to communicate effectively with all levels of Associates, management and senior leaders, including the ability to communicate complex technical material.
Ability to lead and motivate individuals and groups of people toward the accomplishment of work and organizational goals.
Excellent organizational and analytical skills.
Internal Number: #0004
About The Southerland Group/ Methodist LeBonheur Healthcare