Managed Care Contract Consultant

  • Carilion Clinic
  • Roanoke, VA, USA
  • Jan 19, 2021

Job Description

Be at your best with an organization that equips you to do so.  Whose people unite in making lives better. At Carilion Clinic, we help communities stay healthy and our region grow stronger through compassionate care, medical education and research, and neighborhood outreach. As part of our team you can expect professional stability, strong technological resources, and the advancement potential of a regional leader. Based in Roanoke, VA, we are an award-winning, community-based network of hospitals, primary and specialty physician practices, and affiliations with prestigious academic medical institutions. Explore how joining a regional leader can enhance your ability to learn, grow, and succeed. The Managed Care Contract Consultant assists the Director with research, negotiation, development, and maintenance of managed care contracts.  Strategic activities include evaluation of all aspects of existing or proposed contracts; monitoring contract compliance; extraction and evaluation of data; creation of reports and submission of recommendations for improvements related to: contract formulation, negotiations with payers, performance monitoring, billing and collections and legal compliance. Evaluates risk and non-risk contractual arrangements between Carilion Clinic entities and third party payors for the provision of healthcare services to members/patients  Analyzes all aspects of contract proposals including pertinent language, terms, conditions, related financial reports and other data to determine feasibility and conformity to Carilion’s goals and guidelines. Focused evaluation of documents to detect ambiguities, inaccuracies, omissions of essential terms, internal document conflicts and to identify possible legal ramifications.  Negotiates contracts, drafts and coordinates payor contracts, both directly and under supervision. In preparation for review and approval of senior management, converts agreements or agreement proposals into contract format, prepares amended documents to reflect necessary changes and/or alternatives. Responsible for pending contract management through good document controls. Monitors and evaluates contract performance to determine necessity for amendments or contract extensions and compliance to contractual obligations. Notifies payors of all approved changes and requirements; notifies Carilion Clinic service areas of contractual changes. Compiles research data, such as performance requirements, delivery schedules and rate estimates as necessary for preparation of contract proposals, and ensures completeness and accuracy of proposal language. Performs legal research on federal and state regulatory requirements. Serves as health system’s point of contact to research new or significantly changed services and evaluate those impacts on the contractual arrangements with payors.  Advises staff and members of management of contractual risks and obligations. Instrumental in identification of trends, issues and opportunities for operational improvements and/or contract amendments makes suggestions for change as necessary and serves as an advocate for the Carilion service lines to enable successful resolution of issues with payors. Develops pertinent analyses and reports, as needed. In conjunction with department staff, builds and edits third-party payer financial terms and provisions for contracts with commercial insurance, Medicare Managed Care, Medicaid Managed Care, Workers Compensation and employers under direct contract. Serves as liaison between Carilion Clinic and Payor to ensure contractual obligations are met, and reports to management on current/future status of proposed as well as ongoing contracts. MINIMUM QUALIFICATIONS Education: BS in healthcare or business related field required. Master’s degree in healthcare, or business administration strongly desired. Experience: 5 years of related experience required demonstrating: Analytical and problem solving skills, including legal research Effective communication skills, including negotiation experience Detail orientation Proficiency in PC Knowledge of hospital/physician billing and reimbursement Licensure, certification, and/or registration: None Other Minimum Qualifications: Working knowledge of managed care contractual terms and requirements, health insurance practices, industry regulator requirements, business office operations, patient registration, billing and accounts receivable functions, financial reporting technology and industry standards for healthcare revenue resolution management practices.   Effective management skills including time management, communications, human relations, presentation, organizational and analytical skills. Clear and concise communication skills, both oral and written are required.  Must be able to work both independently and in a team setting.  Must be capable of prioritizing multiple projects and meeting deadlines.  Administratively self-sufficient. Professional appearance and presentation required. OUR VALUES Below are our core values that we strive to embody and expect of all our team members: Collaboration: Working together with purpose to achieve shared goals. Commitment:  Unwavering in our quest for exceptional quality and service. Compassion:  Putting heart into everything we do. Courage:  Doing what’s right for our patients without question. Curiosity:  Fostering creativity and innovation in our pursuit of excellence.   Requisition Number: 63178  Employment Status: Full time  Location: CASB - Carilion Administrative Services Building  Shift: Day  Shift Details: Monday - Friday 8am-5pm. Additional hours as needed. Recruiter: DAVID L NIVEN  Recruiter Phone: 540-983-4057  Recruiter Email: dlniven@carilionclinic.org This is Carilion Clinic ... An organization where innovation happens, collaboration is expected and ideas are valued. A not-for-profit, mission-driven health system built on progress and partnerships. A courageous team that is always learning, never discouraged and forever curious. Headquartered in Roanoke, Va., you will find a robust system of award winning hospitals, Level 1 and 3 trauma centers, Level 3 NICU, Institute of Orthopedics and Neurosciences, multi-specialty physician practices, and The Virginia Tech Carilion School of Medicine and Research Institute. Carilion is where you can make your own path, make new discoveries and, most importantly, make a difference. Here, in a place where the air is clean, people are kind and life is good. Make your tomorrow with us. Equal Opportunity Employer Minorities/Females/Protected Veterans/Individuals with Disabilities/Sexual Orientation/Gender Identity Carilion Clinic is a drug-free workplace.