Managed Care Coordinator jobs in Santa Clara, CA

The Managed Care Sales Specialist is responsible for key account Managed Care Sales.  Managed Care sales targets include national payors, national networks, managed care organizations (HMO, PPO, POS, EPO), providers at financial risk (medical groups and IPAs), Self-funded plans, Third Party Administrators, and Workers Compensation payors/networks.

Job Responsibilities:

• Implements corporate strategies to increase revenue and health plan covered lives.
• Identify, develop, implement, and maintain managed care relationships.
• Closing and executing payor contracts and building corresponding covered lives and associated revenue growth.
• Develop business relationships on behalf of the company and effectively build and promote the company’s payer value proposition to national, regional, and local insurance carriers.
• Position home INR monitoring and VAD product lines as well as other identified services to payers and their provider's arms (if applicable) as a superior, preferred, and cost-effective means to support chronic disease management.
• Work in partnership with available resources to develop creative contracting strategies and to close sales opportunities.
• Monitors the healthcare market and recommends new and creative business opportunities as it relates to managed care.
• Establishes guidelines for and negotiates contracts with payer customers for Health products and services to ensure and achieve revenue growth, product implementation, and potential service expansion.
• Successfully implements managed care business plans for sales, product/service development, and provider relations.
• Participates in the development/production of payer proposals and other related correspondence leading to enhanced business revenue. 
• Provides or coordinates clinical support during the sales process to enhance payer awareness and increase utilization of Health products and services.
• Develops and maintains relationships with national, regional, and local key accounts and strategically targets accounts to increase market share and enhance business revenues.
• Ability to obtain and foster positive relationships with key accounts through excellent interpersonal and communication skills.
• Maintains ongoing account management post-contract execution of contracts with assigned payer accounts.
•  Provides proactive customer service, which includes facilitating the resolution of customer issues and fulfillment of customer requests.
• Operates within executive guidelines and corporate objectives to assist in the development of strategic sales and business development proposals. 
• Organizes and manages identified internal and external resources required to implement approved business development initiatives.
• Maintains positive relationships with the payor customer while balancing the best interests in negotiating the contract.
• Facilitates and communicates with finance, sales, operations, clinical, and administrative staff to achieve common goals and objectives.
• Prepares Managed Care updates to assist other departments of Health with the current status of health plan contracts.
• Assists with contract review, interpretation, and adherence to contract terms.
• Interacts, develops, and executes strategies with other business units and partners as appropriate to uncover and close new business opportunities.
• Follows all regulatory policies, procedures, privacy, and security standards in accordance with government agencies including all HIPAA requirements.

Required Qualifications:

• Bachelor’s degree and equivalent experience in healthcare, business, or a related field.
• 6 years of relevant working experience in provider/payor contracting in a managed care sales setting.
• 5 years of face-to-face or over-the-phone sales experience in a healthcare environment.
• Extensive knowledge of health insurance plans (Medicare, Medicaid, Managed Care, PPO, POS, Self-funded, TPAs, Workers Comp, etc.)  and health care environment.
• Proficient in negotiating contracts and agreements.
• Working knowledge of HCPCS and ICD-10 codes
• Advanced Excel skills.
• Excellent written and verbal communication skills

Preferred Qualifications:

• Master’s degree
• Experience in physician, hospital, and disease management sales.
• Works well with management, peers, and subordinates.
• Advanced knowledge of provider contracts and health care reimbursement and the ability to negotiate effectively with internal/external stakeholders and payors. Payors include national payors, national networks, managed care organizations (HMO, PPO, POS, EPO), providers at financial risk (hospital/health system, medical group, and IPA), Self-funded plans, Third Party Administrators, and Workers Compensation payors/networks.