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MC - Hospital Contracts Spec

MC - Hospital Contracts Spec

Job Description

This position evaluates, analyzes, negotiates, implements, and monitors contract rates and terms for facility services provided by PCH in accordance with established contract parameters and timeframes.

PCH Values
  • Family-Centered care that focuses on the need of the child first and values the family as an important member of the care team
  • Excellence in clinical care, service and communication
  • Collaborative within our institution and with others who share our mission and goals
  • Leadership that set the standard for pediatric health care today and innovations of the future
  • Accountability to our patients, community and each other for providing the best in the most cost-effective way.
Position Duties

1. Leads development of rate proposals for negotiations and communication of financial terms to payors. Interacts with payors to gain a thorough understanding of payor-specific coding requirements, reimbursement system logic and payment hierarchies. Acts as primary facilitator for contract management modeling system to ensurev contracts are loaded accurately and timely. Validates contract modeling system parameters are reflective of actual contract terms and identifies parameters with system limitations.
2. Initiates contract discussions with managed care payors, conducts contract language and rate negotiations with payors for professional services in accordance with facility contracting requirements and ensures contract terms can be administered and monitored in a cost effective manner. Effectively interfaces with management, clinical, operations and administrative staff to ensure steps upon which successful contract negotiations are dependant are undertaken in accordance with critical dates.
3. Manages all aspects of the contract life cycle, including pre-negotiation data gathering and business review, contract performance monitoring, language and rate review of existing and proposed contracts and contract negotiation within the established timeframe. Implements contracts cross-functionally, maintains contract databases, and prepares contract status and terms summary reports. Leads discussions pertinent to contract performance, rate and language review/assessment, market changes and other information/business intelligence important to negotiations and business decision-making. Prepares materials and disseminates information as needed for internal and external communication of contract terms and operational requirements for inpatient and outpatient facility services.
4. Facilitates problem solving of operational issues through collaboration with managed care organizations (e.g. payors, networks, health plans, etc.) and internal stakeholders. Resolves contract/claim issues related to facility credentialing/enrollment. Identifies and communicates opportunities for process improvement.
5. Facilitates, negotiates and coordinates the implementation of single case agreements for facility services as well as securing approval for non-standard reimbursement arrangements.
6. Manages multiple projects simultaneously and under tight deadlines and assists with special studies and/or projects related to operations and/or reimbursement; prepares reports of findings and recommendations as appropriate. Participates in special projects as needed to evaluate contract feasibility, operational requirements and reimbursement.
7. Performs miscellaneous job related duties as requested.

Job Requirements

Education Requirements
  • Bachelors in Business, Finance, Health Care Administration or related field. An additional five years comprehensive contract management/negotiation experience may substitute for degree requirement. (Required)
  • MBA or MHA (Preferred)
Experience Requirements
  • Five years hospital reimbursement and contract negotiation experience with three of those years in a managed care setting within a hospital or health plan utilizing reimbursement modeling systems and tools. (Required)
  • Experience in evaluating, analyzing, and presenting financial information. (Required)
  • Experience with Allscripts applications, including AMPFM, SDSM and/or EPSi (Preferred)
  • Experience with transplant reimbursement models and transplant coding and billing requirements. (Preferred)
Skill Requirements
  • Moderate proficiency with Microsoft Professional Suite applications. (Required)
  • In-depth knowledge of facility revenue codes, CPT and HCPCS codes. (Required)
Physical Requirements
  • Physical Requirement - Climbing (Occasionally)
  • Physical Requirement - Hearing (Constantly)
  • Physical Requirement - Reaching (Occasionally)
  • Physical Requirement - Sitting (Constantly)
  • Physical Requirement - Standing (Frequently)
  • Physical Requirement - Talking (Constantly)
  • Physical Requirement - Walking (Frequently)
  • Physical Requirement - Near Vision (Constantly)
  • Physical Requirement - Far Vision (Frequently)
  • Physical Requirement - Color Discrimination (Occasionally)
  • Physical Requirement - Use of keyboard, mouse and/or computer equipment (Constantly)

Job Snapshot

Employment Type Full-Time
Job Type Health Care
Education 4 Year Degree
Experience Not Specified
Manages Others Not Specified
Industry Healthcare - Health Services
Required Travel Not Specified
Job ID 40078
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MC - Hospital Contracts Spec

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