Vice President, Managed Care Services

Job Purpose

The Vice President, Managed Care Services will lead managed care contracting for our end-to-end RCM customers as well as contract management and payment variance departments. The Vice President, Managed Care Services will be responsible to negotiate managed care contracts, single case agreements and provide all areas of managed care support for our end-to-end revenue cycle customers.

Duties and Responsibilities

• Responsible for the oversight, negotiation and strategic direction of managed care contracts for all Med-Metrix end-to-end revenue cycle customers


• Develop processes to manage the implementation of completed contracts and ongoing management of completed contracts including: tracking of critical contract renewal dates, ensuring proper loading of managed care contracts into Med-Metrix contract management system and overseeing the dissemination and communication of contract information to internal stakeholders


• Monitor contract performance regarding financial performance, payment integrity and compliance with contract terms and key performance indicators.


• Oversee payer relationships for Med-Metrix


• Oversee Med-Metrix Contract Management team including the contract load and qa process for all Med-Metrix customers


• Collaborate with development team to identify and implement systematic upgrades to accommodate new pricing methodologies


• Oversee the Payment Variance department including department P&L, collections and payment recovery rates for all managed care customers.


• Provide assistance/resolution to external and internal client inquiries


• Prepare reports or logs as required


• Act as a technical expert in regards to financial class responsibility, to answer questions raised by clients and team members


• Maintain a current working knowledge of all healthcare related issues and regulations especially Managed Care contracts


• Maintain confidentiality at all times


• Learn and comply with organizational and departmental policies and procedures


• Analyze and solve problems quickly and thoroughly


• Establish realistic goals and priorities concurrent with organizational objectives


• Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards


• Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties


• Understand and comply with Information Security and HIPAA policies and procedures at all times


• Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties

Qualifications

• 10 yrs. Minimum experience of managed care contracting within a health system or large medical group and reimbursement analysis in either a provider or payer setting


• Extensive knowledge, experience and expertise in managed care contracting negotiations, language, modeling analytics, reimbursement methodologies for hospitals, shared savings and risk contracting, managed care regulations and quality/shared savings program metrics and methodologies


• Prior Management experience


• Knowledge of governmental, legal and regulatory provisions related to collection activity


• Knowledge of insurance company practices regarding reimbursement


• Excellent written and verbal communication skills


• Excellent interpersonal and organizational skills


• Demonstrated skills in attention to detail, superior project management, analytical ability as well as the ability to coordinate and lead activities using a collaborative team approach


• Ability to handle multiple projects and perform independently under tight deadlines with a focus on effective implementation, clear communication and follow-up


• Ability to work well individually and in a team environment


• Able to work in a professional, corporate setting


• Must be reliable, responsible, goal oriented and flexible

Working Conditions

• Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.


• Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.


• Work Environment: The noise level in the work environment is usually minimal.

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.