Manager: Physician & Ambulatory Contracting

Overview

The Manager, Physician & Ambulatory Contracting reports to the Director of Managed Care and is directly responsible for the physician & ambulatory contracting lifecycle. This individual will assess, develop, negotiate, and implement new and evolving contractual relationships in compliance with industry and organizational best practice.

Responsibilities:

Manager, Physician & Ambulatory Contractor responsibilities include:

• Managed Care:
• Manage all aspects of the contracting lifecycle as they pertain to Physician & Ambulatory entities
• Evaluate and negotiate contracts in compliance with company templates, reimbursement structure standards and other key process controls
• Ensure a stable and economically viable structure of terms and conditions
• Assess and understand the correlation between contract language and payment methodologies
• Build relationships that nurture payor partnerships to seek broader value-based business opportunities to support the physician & ambulatory market strategy.
• Collaborate with medical economics to best support fee-for-service, value-based & revenue cycle opportunities
• Participate as the primary managed care advisor in applicable revenue cycle meetings & projects across the physician & ambulatory enterprise
• Pricing and Reporting
• Oversee and ensure the timely and accurate loading of fee schedules within the Epic Resolute Professional Billing application
• Conduct analysis to quantify and understand variations in yield and payment accuracy
• Perform ongoing market analysis using available external data sources
• Develop service specific and physician level reimbursement analyses and models (involving multiple variables and assumptions) to support a variety of new/revised strategies, approaches, and provisions
• Proactively and appropriately escalate risks, issues, and decisions.
• Builds strong cross-functional relationships within the organization including revenue cycle, ACO, clinical operations, and healthcare informatics, in addition to outside business units or affiliated organizations.
• Has excellent communication skills. Listens well, speaks and writes clearly and concisely. Present in front of a variety of potentially large audiences.
• Displays model behavior. Engages others to foster further development of AHS core values and mission.

Qualifications:

Education:

• Bachelor's degree in Healthcare or Business Administration, Public Health, Mathematics, Healthcare Informatics or similar subject
• Candidates with a Master’s in Health or Business Administration preferred

Requirements:

• Three to five years of contracting experience in a complex and fast paced environment. This requirement may be satisfied in lieu of other achievements, accomplishments of experience at the discretion of department leadership.
• Three years of project management experience or experience and training that includes three years of leading projects related to IT, healthcare, healthcare revenue cycle, healthcare finance, or system implementations.
• Extensive knowledge of managed care financial metrics (fee-for-service, value-based, P4Q, capitation, etc.)
• Highly organized with an emphasis on attention to detail
• Knowledge of physician reimbursement methodologies (CPT code pricing, POS codes, wRVUs, etc.)
• Extensive experience in Microsoft Excel or other business intelligence software packages (building financial models, pivot tables, complex formulas, macros, VBA, dashboards)

Certifications:

• Epic – Resolute Professional Billing, Contracts Administration: though it is preferred that the candidate have an active certification, others will be considered and required to achieve such certification within 9 months of hire.