- Schedule - Shift - Hours: Full Time - Day Shift - M-F 8-4:30
At Moffitt Cancer Center, we strive to be the leader in understanding the complexity of cancer and applying these insights to contribute to the prevention and cure of cancer. Our diverse team of over 9,000 are dedicated to serving our patients and creating a workspace where every individual is recognized and appreciated. For this reason, Moffitt has been recognized on the 2023 Forbes list of America’s Best Large Employers and America’s Best Employers for Women, Computerworld magazine’s list of 100 Best Places to Work in Information Technology, DiversityInc Top Hospitals & Health Systems and continually named one of the Tampa Bay Time’s Top Workplace. Additionally, Moffitt is proud to have earned the prestigious Magnet designation in recognition of its nursing excellence.
Working at Moffitt is both a career and a mission: to contribute to the prevention and cure of cancer. Join our committed team and help shape the future we envision.
Summary
Managed Care Contract Manager
Position Highlights:
- The Managed Care Contract Manager is responsible for analyzing, negotiating and maintaining system-wide Managed Care agreements consistent with Moffitt Cancer Center Guidelines.
- The Managed Care Contract Manager is responsible for managing payer relationships, negotiation of reimbursement rates and contract language, communication and education of contract terms and conditions to appropriate internal parties, researching and resolving managed care related issues, and the analysis of contract performance to expectations.
- This position will serve as a critical resource in supporting, managing and driving strategic projects; and the development and execution of key business strategies for Moffitt Cancer Center managed and value-based care portfolio.
The Ideal Candidate:
- The ideal candidate would have a Juris Doctor (JD) with contract management experience.
Responsibilities:
- Develops, negotiates, administers, and maintains system-wide managed care agreements, including but not limited to, physician, hospital, delegated credentialing and transplant Agreements consistent with Moffitt guidelines and under the direction of the Director of Managed Care.
- Develops and maintains relationships with internal matrix partners and external payer partners.
- Develops strategies, contract language and evaluates financial impact of agreements in alignment with Director of Managed Care.
- Ensures that Moffitt policies and procedures related to delegated physician credentialing are acceptable to managed care plans.
- Analyzes the managed care environment; monitors and communicates trends in national, regional, and local markets.
- Responsible for researching, tracking, trending, and resolving managed care related revenue cycle problems between Moffitt and managed care plans.
- The Managed Care Contract Manager will work with the Revenue Cycle Departments to resolve systemic managed care payment problems and serve as the point person for enforcing the terms of our managed care contracts.
- Evaluates possible reimbursement methodologies and business initiatives in view of their relevance and marketability to payers.
- Analyzes and monitors the financial impact of new and existing managed care agreements in conjunction with the Director of Managed Care.
- Identifies opportunities to gain efficiencies and greater effectiveness in contracts.
- Supports Moffitt growth strategies by being a subject matter expert on payment implications for new opportunities.
- Assists various Moffitt Departments with resolving patient access issues related to patient insurance.
- Provides support to individual patient Letters of Agreement with non-contracted payers as needed.
- Serves as the Managed Care Department’s liaison within Moffitt and as an organization-wide resource for managed care related issues.
- Resolves issues that arise between Moffitt and managed care organizations.
- Provides appropriate physician and staff education to support the managed care activities of Moffitt.
Credentials and Experience:
- Bachelor’s Degree – field of study: Healthcare, Finance or related field.
- Minimum five (5) years of progressively challenging experience in managed care contracting, either in a hospital, health system, or managed care organization.
Skills:
- Skill in composing and editing documents to include contracts, correspondence, and reports.
- Demonstrated skill in evaluating, monitoring, and improving existing contracts.
- Comprehensive knowledge and understanding of managed care principles and practices, experience in fee-for-service and value-based payment models.
- Demonstrated track record of success in negotiating with third parties.
- Proven ability to prepare and present managed care strategies for team, stakeholders and leadership.
- High proficiencies with Microsoft tools (primarily Word, Excel and Power Point).
- Demonstrated analytical skills, including financial modeling and reimbursement technologies.
- Excellent written and oral presentation skills.
- Demonstrated success in building positive and effective relationships with physicians, leadership, and team members.
- Knowledge of both payer and hospital/physician managed care operations.
- Demonstrated knowledge of Federal and State Regulations, including Medicare, Medicaid, and ERISA.
Moffitt Cancer Center is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, or protected veteran or disabled status.
Reasonable Accommodation
Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job.
#J-18808-Ljbffr
