Managed Care Contract Specialist (Remote)
Alliance HealthCare Services
Remote
managed care
contract specialist
remote
healthcare
radiology
medicare
medicaid
patients
operational
health
medical
life insurance
insurance
March 16, 2023
Alliance HealthCare Services
Denver, Colorado
CONTRACTOR
*About Us* Welcome to Alliance HealthCare Services, an Akumin company. As a leading provider of radiology and oncology services in the United States, we are dedicated to improving the diagnosis and treatment of patients through the use of advanced technology and expert clinical and operational knowledge.
Our network of owned and operated imaging locations offers a range of outpatient diagnostic procedures, including MRI, CT, PET, and more. In addition, we provide a full suite of diagnostic imaging and cancer care services, including radiation therapy, to over 1,000 hospitals and health systems across 48 states. Our goal is to make healthcare more efficient and effective for both patients and providers.
Thank you for considering a career with us! Benefits Offered Depending on Eligibility: Medical, Prescription, Dental & Vision Savings and Spending Accounts: HSA & FSA Company Paid Life Insurance, AD&D and Disability Supplemental Life Insurance and AD&D Employee Assistant Program Retirement Plan and Company Match Paid Time Off: Vacation, Sick, & Holiday Additional Voluntary Benefits!.Job Responsibilities* The.Managed Care Contract Specialist* serves as a liaison between the Payor, Radiology Benefit Management (RBM) and Broker community.
This position will maintain regular and consistent contact with all contracted Payors. Specific duties include, but are not limited to: + Serves as the primary contact and liaison with all assigned Payors: + Maintains regular contact with all assigned Payors via phone conversations/e-mail and maintains Payor contact information. + Proactively obtains and tracks all changes that assigned Payors are planning related to fee schedules, new products, plan design changes, authorization guideline changes, and Payor use of an RBM.
+ Research and communicate changes to Payor policies, fee schedule changes, new product lines, plan design changes, authorization guideline changes and the beginning or ending use of an RBM for all or particular services. + Monitors all changes to Medicare and Medicaid rates as it relates to Payor contracts. + Negotiates Payor contracts including new Payors and re-contracting of existing Payors as well as amendments to Payor contracts and patient specific letters of agreements: + Prepares financial analysis for each contract to show the impact the proposed reimbursement will have on a particular location, as well as counter proposals as necessary.
+ Keep abreast of and understand the Payor market for all assigned Payors including Payors that are not contracted in the market and why, and work to cultivate new non-traditional payer/program models to align with market model innovations and diversification of the Alliance Payor portfolio. + Responsible for language review, coordination with Payor to draft changes and prepare necessary documents for legal review as well as complete all necessary applications. + Facilitate the operational implementation of all new and changed agreements across the organization and all applicable departments, ensures reimbursement rates are loaded in the billing system, and confirms the Payor website has the contracted locations loaded appropriately.
+ Assists with the maintenance of rate information in external-facing price transparency websites where applicable. + Troubleshoot problems pertaining to contractual issues: + Assist in resolving claim and authorization issues related to contractual or data errors. + Ability to articulate Payor processes to billing and scheduling departments.
+ Additional duties as assigned Position Requirements* + High school diploma or equivalent experience required; Associate's degree preferred. + Minimum of 5 years Medical Group/Independent Physicians Association (IPA), Hospital/Health System negotiations and contracting including Commercial, Medicare, Medicaid and Workers' Compensation plans required. + Previous experience contracting for Radiology Services preferred.
+ Previous experience contracting in an Independent Diagnostic Testing Facility (IDTF) and Professional Group environment. + Must possess the skills necessary to strategize, construct and negotiate various rate structures and contract language and can demonstrate successful negotiations that require this skill set. + Knowledge and understanding of Payor, Provider, Medicare and Medicaid reimbursement formulas.
+ Ability to identify errors in the data and the knowledge of how to correct the errors. + Ability to develop breakeven analysis between increased revenue vs increased scan volume. + Excellent negotiation, group facilitation, written and verbal communication skills.
+ Ability to write and present effectively, adjust message to fit the audience and deliver a persuasive message. + Must be self-motivated, reliable and capable of working independently as well as part of a team. + Excellent problem solving skills with the ability to draw valid conclusions by applying sound reasoning and judgement in making decisions.
+ Working knowledge of the Microsoft office suite of products. + Must be results oriented and capable of managing work to satisfy all Managed Care department and individual Key Performance Indicators (KPI's). + Job may require 5% of local travel.
+ The COVID-19 vaccination is/may be a condition of employment Residents living in CA, NY, Jersey City, NJ, WA and CO clickhere (https://alliancehealthcareservices.icims.com/icims2/servlet/icims2?module=AppInert&action=download&id=1132250&hashed=1281094304) to view pay range information.* Alliance Healthcare Services, Inc.
and its divisions are subsidiaries of Akumin Operating Corp, and we are an equal opportunity employer and we believe in strength through diversity. All qualified applicants will receive consideration for employment without regard to, among other things, age, race, religion, color, national origin, sex, sexual orientation, gender identity & expression, status as a protected veteran, or disability Job Locations* _US-CA-Irvine | US-AZ-Phoenix | US-AZ-Tucson | US-AZ-Flagstaff | US-CO-Denver | US-UT-Salt Lake City | US-WA-Seattle | US-OR-Portland | US-OR-Portland_.ID* _2023-22541_.Category* _Business Services_.
Position Type* _full-time_.
Our network of owned and operated imaging locations offers a range of outpatient diagnostic procedures, including MRI, CT, PET, and more. In addition, we provide a full suite of diagnostic imaging and cancer care services, including radiation therapy, to over 1,000 hospitals and health systems across 48 states. Our goal is to make healthcare more efficient and effective for both patients and providers.
Thank you for considering a career with us! Benefits Offered Depending on Eligibility: Medical, Prescription, Dental & Vision Savings and Spending Accounts: HSA & FSA Company Paid Life Insurance, AD&D and Disability Supplemental Life Insurance and AD&D Employee Assistant Program Retirement Plan and Company Match Paid Time Off: Vacation, Sick, & Holiday Additional Voluntary Benefits!.Job Responsibilities* The.Managed Care Contract Specialist* serves as a liaison between the Payor, Radiology Benefit Management (RBM) and Broker community.
This position will maintain regular and consistent contact with all contracted Payors. Specific duties include, but are not limited to: + Serves as the primary contact and liaison with all assigned Payors: + Maintains regular contact with all assigned Payors via phone conversations/e-mail and maintains Payor contact information. + Proactively obtains and tracks all changes that assigned Payors are planning related to fee schedules, new products, plan design changes, authorization guideline changes, and Payor use of an RBM.
+ Research and communicate changes to Payor policies, fee schedule changes, new product lines, plan design changes, authorization guideline changes and the beginning or ending use of an RBM for all or particular services. + Monitors all changes to Medicare and Medicaid rates as it relates to Payor contracts. + Negotiates Payor contracts including new Payors and re-contracting of existing Payors as well as amendments to Payor contracts and patient specific letters of agreements: + Prepares financial analysis for each contract to show the impact the proposed reimbursement will have on a particular location, as well as counter proposals as necessary.
+ Keep abreast of and understand the Payor market for all assigned Payors including Payors that are not contracted in the market and why, and work to cultivate new non-traditional payer/program models to align with market model innovations and diversification of the Alliance Payor portfolio. + Responsible for language review, coordination with Payor to draft changes and prepare necessary documents for legal review as well as complete all necessary applications. + Facilitate the operational implementation of all new and changed agreements across the organization and all applicable departments, ensures reimbursement rates are loaded in the billing system, and confirms the Payor website has the contracted locations loaded appropriately.
+ Assists with the maintenance of rate information in external-facing price transparency websites where applicable. + Troubleshoot problems pertaining to contractual issues: + Assist in resolving claim and authorization issues related to contractual or data errors. + Ability to articulate Payor processes to billing and scheduling departments.
+ Additional duties as assigned Position Requirements* + High school diploma or equivalent experience required; Associate's degree preferred. + Minimum of 5 years Medical Group/Independent Physicians Association (IPA), Hospital/Health System negotiations and contracting including Commercial, Medicare, Medicaid and Workers' Compensation plans required. + Previous experience contracting for Radiology Services preferred.
+ Previous experience contracting in an Independent Diagnostic Testing Facility (IDTF) and Professional Group environment. + Must possess the skills necessary to strategize, construct and negotiate various rate structures and contract language and can demonstrate successful negotiations that require this skill set. + Knowledge and understanding of Payor, Provider, Medicare and Medicaid reimbursement formulas.
+ Ability to identify errors in the data and the knowledge of how to correct the errors. + Ability to develop breakeven analysis between increased revenue vs increased scan volume. + Excellent negotiation, group facilitation, written and verbal communication skills.
+ Ability to write and present effectively, adjust message to fit the audience and deliver a persuasive message. + Must be self-motivated, reliable and capable of working independently as well as part of a team. + Excellent problem solving skills with the ability to draw valid conclusions by applying sound reasoning and judgement in making decisions.
+ Working knowledge of the Microsoft office suite of products. + Must be results oriented and capable of managing work to satisfy all Managed Care department and individual Key Performance Indicators (KPI's). + Job may require 5% of local travel.
+ The COVID-19 vaccination is/may be a condition of employment Residents living in CA, NY, Jersey City, NJ, WA and CO clickhere (https://alliancehealthcareservices.icims.com/icims2/servlet/icims2?module=AppInert&action=download&id=1132250&hashed=1281094304) to view pay range information.* Alliance Healthcare Services, Inc.
and its divisions are subsidiaries of Akumin Operating Corp, and we are an equal opportunity employer and we believe in strength through diversity. All qualified applicants will receive consideration for employment without regard to, among other things, age, race, religion, color, national origin, sex, sexual orientation, gender identity & expression, status as a protected veteran, or disability Job Locations* _US-CA-Irvine | US-AZ-Phoenix | US-AZ-Tucson | US-AZ-Flagstaff | US-CO-Denver | US-UT-Salt Lake City | US-WA-Seattle | US-OR-Portland | US-OR-Portland_.ID* _2023-22541_.Category* _Business Services_.
Position Type* _full-time_.
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