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Managed Care Contracting & Relations Manager

Title: Managed Care Contracting & Relations Manager

Reports to: Director of Finance

Function Summary:

This position supports the operations of AHSS/Invo by performing activities involved in insurance management & payer relations. To that end, this position is responsible for identifying, targeting, and maintaining strategic transactional relationships with physician groups, managed care organizations, and hospital systems with the goal of establishing mutually-beneficial relationships as an in-network provider. Other responsibilities include negotiating contracts and building ongoing relationships with managed care & HMO groups and maintaining a database of partner contacts, contracts, requirements (e.g., related to individual medical policies), timelines for renewals and follow ups, etc., and providing critical support in new markets by identifying necessary resources and contacts to assure reimbursement success. This position works closely with the Director of Finance; Manager of Insurance & Billing; Chief Clinical Officer; Training, Quality, & Privacy Director, and, as needed, other members of the organization.

Principal Responsibilities:

  • Educate AHSS/Invo on managed care; contracting; and related protocols, policies, and procedures
  • Research and establish new payer relationships in breakout markets for AHSS, including establishing payer contacts, reviewing requirements, processing documentation, and maintaining such relationships over time  
  • Work closely with the finance department to understand and advocate for economically-sustainable rates and to provide insurance partners with data and analysis to support such arrangements
  • Negotiate terms of contractual arrangements (initial & renewal) with physician groups, hospital systems, Independent Practice Associations (IPAs), and managed healthcare firms within established limits, both on a group/organizational basis and as single case agreements
  • Work with the clinical team to negotiate & execute contracts with school districts on an as needed basis
  • Educate payer partners (active and potential) about ABA, the standard service models, and AHSS/Invo-specific services (in coordination with clinical leadership) to facilitate sustainable relationships and advocate for increased coverage where appropriate (e.g., use of telehealth, understanding of importance of indirect activities, etc.)
  • Participate as an active member of departmental & cross-functional teams through sharing ideas, proactively raising concerns and solutions, and dedication to improving internal quality
  • Ensures provider database and documentation is up-to-date, accurate, and complete
  • Serves as resource and trainer for insurance specialist team in all functional areas
  • Identifies and communicates business and payer changes that affect immediate and future needs, processes, etc. and works with the affected departments & organizations to develop meaningful solutions
  • Coordinate with clinical leadership to ensure collaborative relationships, effective communication, and creative problem solving, both internally and externally, related to the interaction of clinical quality initiatives and payer policies and requirements
  • Performs other related projects and duties as assigned by supervisor

Technical Knowledge, Experience and Skill Requirements:

  • Bachelor’s Degree in the healthcare field
  • At least 5 years of previous experience in a healthcare organization with a focus on contracting and financial analysis required
  • Excellent oral and written communication and interpersonal skills required
  • Excellent analytical skills required
  • Knowledge of provider contracting, financial arrangements, and fee schedules, including understanding of healthcare reimbursement methodologies and guidelines preferred

Abilities & Personal Characteristics Required:

  • AHSS/Invo core values--empathy, positivity, growth, integrity, service, & teamwork
  • Ability to act with sense of urgency to meet client needs
  • Must work well in a team environment, including being open minded & creative in problem solving
  • Ability to learn new organization systems, processes, and software quickly
  • Proficient in Word, Excel, and PowerPoint, as well as the Google Suite
  • Experience in CentralReach Practice Management and Tableau a plus

 

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