Managed Care Contract Reimbursement Consultant Hybrid/Remote
Job Posting for Managed Care Contract Reimbursement Consultant Hybrid/Remote at Henry Ford Health - Careers
GENERAL SUMMARY:
Under minimal supervision of the Manager, independently leads financial and data analysis to evaluate rate proposals, contract terms, and health plan reimbursement. This position will proactively identify rates, methodologies, and processes that need improvement and will develop and implement solutions to optimize reimbursement.
PRINCIPLE DUTIES AND RESPONSIBILITIES:
1. Manage specific payor relationships for contracting purposes.
2. Lead the development of financial reporting and analysis using tools such as EPSi, SQL, Epic Clarity, and Power BI to extract and analyze data for the purpose of assessing contracted rates and reimbursement methodologies.
3. Generate proactive analysis and make recommendations to Contracting leadership based on review and identification of payer performance reporting trends.
4. Lead evaluation, and creation, of metrics and processes to improve and / or track rates against industry averages to identify gaps and areas for improvement.
5. Manage the rate review process for existing and proposed contracts to evaluate budgetary impact, verify that all necessary reimbursement terms are addressed, and the rates are depicted as negotiated.
6. Coordinate with contract modeling team the implementation and maintenance of contract management/pricing systems.
7. Maintain expertise in reimbursement methodologies, payer policies, and regulatory changes as they apply to payor contracts.
8. Manage and complete special projects and attends various meetings.
9. Coordinate and support Contracting projects for business units across the Health System
EDUCATION/EXPERIENCE REQUIRED:
- Bachelor's degree in Finance, Accounting, Business Administration, Managed Care Contracting, Reimbursement, or related field. Master's Degree preferred.
- Five to seven (5-7) years of experience in healthcare finance, managed care contracting, or reimbursement in a professional capacity including experience with various reimbursement methodologies (DRGs, per diems, fee schedules, case rates, etc.).
- Report writing capabilities or ability / willingness to learn.
- Strong Analytical and Critically Thinking skills (via curiosity, creativity, skepticism, and adept in use of logic) relative to accomplishing business objective and problem solving.
- Detail oriented. Proficient in Microsoft Excel (queries, reports, pivots, What If scenarios and database mgmt. a plus).
- Proficient in Data extraction & reporting tools (EPSi, SQL, Clarity, etc.).
- Excellent oral and written communication skills.
- Strong organizational and interpersonal skills.
- Strong Understanding of Managed Care Reimbursement methodologies, coding, and terminology.
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