Managed Care Provider Relations Manager jobs in South Bend, IN

• Granger, IN
• Managed Care
• Beacon Health System
• Full-time - Day - 0800-1700 M-F
• Req #: 211771
Posted: Today-->

Summary

Reports to the Executive Director. Responsible for assisting the Managed Care Executive Team in negotiating, maintenance, problem resolution and internal coordination of assigned managed care contracts and proposals for Beacon Health System. Works with the Managed Care Executive team to manage the contract process for Beacon Health System. Acts as a service representative for internal clients and payors, scheduling in-services as needed and works to provide information to Beacon Entities to enable them to operationalize their managed care agreements. Responsible for maintaining contracting files. Supports the management team by providing input into the strategic planning process. Responsible to assist with the Beacon ACO as directed.

MISSION, VALUES and SERVICE GOALS

• MISSION:We deliver outstanding care, inspire health, and connect with heart.
• VALUES:Trust. Respect. Integrity. Compassion.
• SERVICE GOALS:Personally connect. Keep everyone informed. Be on their team.

Maintains coordination for Managed Care contracts with involved entities and is responsible for customer service representation to all clients by:

• Notifying appropriate entities of all new contracts and any alterations of current contracts.
• Developing and circulating all quarterly reports.
• Working on the development of managed care contracts and proposed protocols with the assistance of management.
• Handling contract negotiation/renewal processes and/or undertaking these tasks as directed and/or necessary with the assistance of management.
• Works with the Managed Care enrollment team to coordinate the completion of the enrollment paperwork of new payors.
• Serving as a liaison with attorney regarding contract language.
• Attend all applicable meetings necessary to obtain approval on proposed agreements by Beacon Entities.

Coordinates Managed Care activities, as well as serving as a liaison to the Hospital Finance Department, by:

• Maintaining current contracts, credentialing information and roster of clients.
• Notifying appropriate entities of new payor groups.
• Coordinating activities and resolving problems of key internal functions such as Accounting, Billing, Collections and Registration.
• Assisting management with new product design.
• Assisting in the development and maintenance of policies and procedures to most effectively manage and monitor Managed Care activities.
• Coordinate with Executive Director for evaluation and modeling of proposed financial terms, making recommendations based upon the financial analysis performed to prepare for counter proposals to payers.
• Present new contracts and or revised fee proposals to the appropriate Beacon Entity for approval.

Serves as Managed Care System Administrator by:

• Maintaining current knowledge base on benefit and network designs to act as service representative for internal and external contacts and maintaining payor database.
• Coordinating and conducting training as needed for administrative staff.
• Maintaining information on the intranet site.
• Conduct and/or arrange regular education trainings for contracted managed care companies to ensure managed care provider tools and resources are known.
• Assess performance of contracted agreements for each Beacon Entity and communicate those findings to management to compose contracting strategies and goals yearly.

Supports the management team by:

• Providing input into the departmental strategic planning process.
• Coordinating with sales staff and assisting with Requests for Information (RFI's).

Performs other functions to maintain personal competence and contribute to the overall effectiveness of the department by:

• Completing other job-related assignments and special projects as directed.
• Perform functions for Beacon ACO as directed.

ORGANIZATIONAL RESPONSIBILITIES

Associate complies with the following organizational requirements:

• Attends and participates in department meetings and is accountable for all information shared.
• Completes mandatory education, annual competencies and department specific education within established timeframes.
• Completes annual employee health requirements within established timeframes.
• Maintains license/certification, registration in good standing throughout fiscal year.
• Direct patient care providers are required to maintain current BCLS (CPR) and other certifications as required by position/department.
• Consistently utilizes appropriate universal precautions, protective equipment, and ergonomic techniques to protect patient and self.
• Adheres to regulatory agency requirements, survey process and compliance.
• Complies with established organization and department policies.
• Available to work overtime in addition to working additional or other shifts and schedules when required.

Commitment to Beacon's six-point Operating System, referred to as The Beacon Way:

• Leverage innovation everywhere.
• Cultivate human talent.
• Embrace performance improvement.
• Build greatness through accountability.
• Use information to improve and advance.
• Communicate clearly and continuously.

Education and Experience

• The knowledge, skills and abilities as indicated below are normally acquired through the successful completion of a Bachelor's Degree in Business, Economics, Marketing or a related field. A minimum of three years of managed care and group insurance experience, through which a background in Medicaid, Medicare and physician contracting was gained, is required. Prefer candidate to have experience in contracting for providers/facilities in the State of Michigan.

Knowledge & Skills

• Requires an in-depth knowledge and understanding of employee benefit products/plans, including health/medical, dental and workers compensation, case processing (proposal, renewal, plan design, billing, claims, etc.) and the regulatory provisions of the Health Insurance Portability & Accountability Act of 1996 (HIPAA).
• Requires well-developed knowledge and understanding of PHO, HMO, PPO and POS healthcare delivery systems.
• Demonstrates proficiency in basic computer skills (i.e. data entry, word processing, spreadsheets and database applications).
• Requires strong skills in organization, time management, research and analysis.
• Requires an in-depth understanding of contractual language, computer systems, accounting and finance.
• Demonstrates well-developed communication skills necessary to effectively communicate both verbally and in writing and to make presentations to individuals and small and large groups.
• Demonstrates a high level of interpersonal skills in order to ensure that effective relationships are developed, maintained and managed in a professional and effective manner with medical staff members, Hospital and System management team, patients, representatives of client organizations, business leaders, various public managers, physician groups and legal counsel.

Working Conditions

• Works in an office environment.
• May be required to vary hours and days, and work on holidays, etc., depending upon the needs of the department.

Physical Demands

• Requires the physical ability and stamina to perform the essential functions of the position.