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Managed Care Contract Administrator - Houston TX USA - MAX SALARY $140,000

Note: Applicant must be resident of the USA or Green Card Holder.

Must-Haves

• Three (3) to five (5) years experience in managed care contracting either from the provider or the payor side.
• Contract negotiation experience with insurance payors (commercial payors and government payors)
• Hospital, Physician Group, Ancillary and Transplant agreement or contracting experience
• Healthcare reimbursement methodology
• Strong finance analytical skills

Nice-To-Haves

• ACO (Accountable Care Organization) contracting experience
• Strong communication skills and ability to interact with leaders of all levels
• Intermediate Excel skills (Pivot tables, V Lookup, formulas)

Job Description

Minimum Qualifications

• Education: Bachelors degree in Business, Marketing, Healthcare Administration, or related field preferred. In lieu of degree, relevant work experience will be reviewed.

Licenses/Certifications: (None)

Experience / Knowledge / Skills:

• Three (3) to five (5) years experience in managed care contracting either from the provider or the payor side. In lieu of the Bachelors degree referenced above, ten (10) years relevant experience is acceptable.
• Strong interpersonal and communication skills

Excellent presentation skills

Demonstrates commitment to the Partners-in-Caring process by integrating our culture in all internal and external customer interactions; delivers on our brand promise of we advance health through innovation, accountability, empowerment, collaboration, compassion and results while ensuring one.

Principal Accountabilities

• Monitors operational compliance of assigned managed care agreements.
• Develops and maintains effective working relationships with insurance company and managed care company personnel responsible for contracting with healthcare providers.
• Negotiates managed care contracts including language, rates, amendments, etc. and monitors financial performance maximizing opportunities for net revenue improvement, volume/growth, and effectiveness of collection efforts.
• Assists in the development and implementation of new reimbursement mechanisms for managed care contracts such as case rates, package or global pricing rates, medical diagnosis categories, capitation, etc.
• Assists in the development and implementation of new types of structural contracting mechanisms such as alliances, subcontracts and contractual joint ventures which will benefit Memorial Hermann in securing managed care contracts.
• Assists physicians in their relations with managed care companies and coordinates communications between managed care companies and physicians.
• Obtains managed care agreements and assists Memorial Hermann ancillary companies in their relations with managed care companies.
• Maintains close liaison with payors, Memorial Hermann ancillary providers, Memorial Hermann joint venture partners, and all supporting hospital system departments (e.g. Patient Business Services, Medical Management, Patient Access, Decision Support, etc.).
• Acts as the Memorial Hermann representative for inquiries from patients, providers, and managed care companies regarding claims issues and special negotiated services.
• Ensures safe care to patients, staffs and visitors; adheres to all policies, procedures, and standards, within budgetary specifications, including time management, supply management, productivity, and accuracy of practice.
• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education, skills competency, supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor, and resource to less experienced staff.
• Other duties as assigned.

Screening Questions

• Describe hospital and physician manage care reimbursement methodologies?
• Are you willing to adhere to our mandatory COVID vaccination policy?
• Do you smoke or use any nicotine products in any form?

Interview Steps

• Initial contact from the recruiter to complete HR phone screening
• Candidate to complete HR assessment
• Interview with hiring leader - second interview conducted if needed

Benefits

• Dental
• Medical life
• Retirement paid time off
• Equity
• Vision