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Job Title:
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Managed Care Contracts Manager
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Minimum Requirements:
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To qualify, candidates should possess the following:
-4 - 6 years experience in a managed care environment; 1-2 years management experience preferred.
-High School Diploma or general education degree (GED) required. Bachelor's degree preferred, but not required.
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State:
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North Carolina
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City:
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Raleigh
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Description:
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Responsible for overall administration of all documentation relating to managed care contracts. Reviews all new or amended client contracts completed by the Managed Care Contract Administrator for acceptable terms prior to delivery of document to the Director of Managed Care or General Counsel. Ensures that all contract guidelines are verified and followed.
Specific duties include, but are not limited to:
1. Assist in Market Research specific to New Modalities, Payor Trends, Reimbursement Analysis and Methodologies, Managed Care Forecasting
2. Reviews all new or amended client contracts completed by the Managed Care Contract Administrator for acceptable terms prior to delivery of document to the General Counsel. Ensures that all contract guidelines are verified and followed..
3. Responsible for coordinating any changes to the Managed Care payor database and the AIN.
4. Negotiates rates and language for managed care contracts with managed care companies, IPA/Medical groups, etc.
5. Interfaces with Scheduling and Billing departments and payors regarding AIN and retail sites, Medicare issues, regulatory compliance and reimbursement issues.
6. Monitor's and updates all NE Retail payor reimbursement detailing technical and/or professional reimbursement payouts for various diagnostic tests (i.e., MRI, CT, PET, radiation therapy, etc.).
7. Responsible for securing marketing leads for expansion of managed care contracts. Identifies, develops and implements managed care marketing strategies to promote new business and to sustain existing business. May also attend meetings with various managed care, physician groups and joint venture board meetings to develop large contracts.
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Relocation Available:
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