We are on a mission to transform fertility and family-building care, making it more accessible, intuitive, and empowering - for all. We leverage modern proprietary technology to deliver a superior experience, improved outcomes, and reduced pricing for patients and employers, and for all gender identities, races, and humans. Join our experienced team of rockstars from Stanford, Mercer, Oscar, Progyny, Mount Sinai, One Medical and Castlight to change healthcare forever.

As a member of the Revenue Cycle team, you will be responsible for negotiating, maintaining payer contracts and fee schedules. The Managed Care Contract Manager will work in a fast-paced, rapidly growing environment where they will be relied on for their expertise, professionalism, and collaboration. We are looking for a dedicated individual to join our team to support our revenue cycle, employer, clinic, and operations team. 

Responsibilities:

  • Serves as a critical resource for managing payer relationships,  contract negotiations/renegotiations  including financial impact of reimbursements, trends and provides advanced analytical solutions to influence decision making at senior level of the organization.
  • Contract Modeling
  • Monitors and analyzes performance of contracted payers including volume, revenue, average rates.
  • Analyze new service line reimbursement and identify contracting opportunities/needs
  • Review contract compliance data to ensure contract terms are adhered to and lead any efforts needed to ensure compliance/reimbursement according to contract terms.
  • Investigates systemic payment issues identified by analyses (reviewing claims data and comparing against contract terms and payer payments) or communicated by the revenue cycle team. Escalates to plan contacts for resolution and makes recommendations that addresses the prevention of such issues.
  • Coordinates, compiles, models and analyzes the financial impact of new and existing contract terms utilizing spreadsheets and/or database applications.
  • Develops and maintains a complete library of payor contract documentation for each payor including contract summary documents, copies of all fully-executed contracts with related amendments, letters, policies and other operational reference materials.
  • Creates and manages learning materials and quick reference guides to assist in the education of other departments regarding plan-specific managed care policies and procedures.
  • Develop and maintain contracting tools for use by Revenue Cycle staff to include; summary of contracts, applicable fee schedules, grouper listings, etc.
  • Provides necessary training to other departments on contracts fee schedules and policy and procedures.
  • Maintains a consistent timeline for evaluating contracts and renegotiations.
  • Manages credentialing staff and provides direction to ensure proper prioritization of time, strategic planning, and teamwork. Responsible for coaching, skill development and motivation of staff.
  • Ensures contracted rates and any fee updates are loaded and maintained in the contract management systems in a timely manner. Works closely with the Revenue Cycle/Engineering teams to ensure accuracy of fee schedule load in practice management system.

 

Qualifications

  • Bachelor’s Degree in business, healthcare management, science or other relevant discipline is required.
  • Minimum of 5 years of healthcare contracting &  analysis is required.
  • Solid working knowledge of healthcare terminology including knowledge of contract language (particularly those provisions that have financial cost impacts), provider reimbursement methodologies and insurance terms.
  • Proficiency in collecting information from diverse sources, analyzing and summarizing the information and data in order to solve problems.
  • Proficiency in MS Office including Word, Excel, PowerPoint.
  • Advanced organizational skills, follow-up and follow-through skills.
  • Excellent verbal and written communication skills and an ability to synthesize and present results in a clear and concise manner.

 

If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!

 

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