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Manager, Payer Contracts (Amarillo, TX)


Manager, Payer Contracts (Amarillo, TX)

Manager, Payer Contracts (Amarillo, TX)

BSA Health System
Amarillo, TX 79106

Job details

Job Type

Full-time

Ardent Health Services invests in people, technology, facilities, and communities, producing high-quality care and extraordinary results. Based in Nashville, Tennessee, Ardent’s subsidiaries own and operate 30 hospitals in six states with 26,000 employees including 1,000+ employed providers. Ardent facilities exceed national averages in Overall Hospital Quality Star Rating as ranked by the Centers for Medicare & Medicaid Services; 89 percent of its hospitals received a three-star rating or above in comparison with 73 percent of all hospitals ranked Ardent's corporate office has been named "Top Work Places" for Nashville based companies for 5 consecutive years including 2021.
We have an exciting opportunity to join our Payer Strategies team as Manager, Payer Contracts supporting BSA Health System in Amarillo, TX and Seton Medical Center in Harker Heights, TX. This position will work in Amarillo, TX.
POSITION SUMMARY
Reporting to the Director, Payer Contracts, the Manager, Payer Contracts will serve as a liaison to health plans on behalf of Ardent Health and will participate in the renegotiation of contracts, such as fee for services agreements, value-based care delivery programs, which includes episodic-based payments, and alternative service delivery models and payment. The Manager will assist the leadership team in managing joint operating committees with health plan payers which includes financial reconciliation and true-ups, clinical case reviews, and networking and marketing opportunities. This role will also negotiate new product contracts and monitor the growth of these products versus budget. The Manager will have a strong focus on resolving claims issues and decreasing the administrative burden of working with managed care organizations.
Primary Responsibilities:

  • Assists in managing health plan contracts and ensures terms and rates are aligned with the strategic goals and objectives of Ardent Health pertaining to revenue and yield. Renegotiates contracts, in conjunction with leadership, as needed.
  • Manages relationships with health plans on behalf of the enterprise by maintaining regular contact with key leaders at each health plan.
  • Participates in strategic meetings with key hospital, ACO/IPA provider organizations focused on developing value/risk-based partnerships.
  • Evaluates business processes and identifies issues/areas of opportunity; collaborates with internal departments (Finance, Legal, Operations, Business Development, Managed Care Services Unit, Revenue Cycle, etc.) and external health plan payers to improve/modify business processes.
  • Assists in negotiating new rates and value-based relationships with health plans based on financial modeling.
  • Participates in joint operating committees with health plan payers to reconcile value-based payments and incentives/penalties with performance reporting related to quality, customers, expenses, and total cost of care when applicable.
  • Collaborates with appropriate internal departments to resolve or challenge health plan payer denials to maximize reimbursement.
  • Identifies and evaluates issues and opportunities related to health plan business processes; makes recommendations for improvements and leads implementation of changes.
  • Liaises with internal partners to facilitate single case agreements with non-contracted health plans such as rate negotiation, securing an authorization, and/or arranging for any special handling that might be required with AHS internal departments.
  • Monitors the health plan industry for emerging/changing trends and provides proactive recommendations for Ardent Health to adapt to the ever-changing industry.
  • Performs all duties inherent in a managerial role: ensures effective staff training, evaluates staff performance, provides input for the development of the department budget, and hires, promotes, terminates staff, and recommends salary actions as appropriate.
  • Participates in special projects and negotiates contracts as assigned.

**
*Experience: *

  • 5+ years of experience negotiating and managing contracts required, preferably in healthcare
  • 3+ years of supervisory experience, preferably in healthcare
  • Experience in large, multi-facility organization, preferred
  • Multi-state experience, preferred
  • Previous experience with an insurance provider, preferred

Behavior Standards:

  • Service – Patient Centered Customer Service
  • Quality – Clinical and Operational Excellence
  • People – Promotes a Collaborative Environment
  • Financial – Business Acumen
  • Growth – Fosters Innovation

Job Type: Full-time


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• Location: NA

• Post ID: 21178577


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