Managed Care Contract Specialist (FT) 8a-5p Johnson City, TN

Managed Care Contract Specialist (FT) 8a-5p Johnson City, TN

Job ID: 004GNF

BALLAD CORPORATE

Corporate - Payor Strategy

Full-time (scheduled 72 hrs or more per pay period) - Day

Job Description

SCOPE OF POSITION
Assists Corporate Manager in language negotiations between payors and all Ballad Health facilities. This includes extensive language due diligence and contract review, but is not limited to: provider manual and website review, and internal research regarding the feasibility of payor guidelines. This position leads all aspects of negotiations and/or addition of new services' language review and rate review for goodwill related contracts for all Ballad Health facilities. Process requires contract and rates knowledge, coordination, communication, attention to detail, teamwork, and a positive attitude towards stressful situations. This position is responsible for and leads the contract compliance performance improvement teams.
When Ballad Health acquires additional entities, this position assists the Corporate Manager with all managed care transitions in due diligence by developing contract grids and providing internal education.
This position manages all Ballad Health-wide education and teaches managed care information classes, which includes off-site travel. Responsible for insurance plan education, quarterly training, and reviews all Managed Care newsletters for payor updates as required. Co-Trainer to Admitting, Denials Management, Central Business Office, Patient Resource Management, and other Ballad Health departments for managed care payors, including pre-certification services, concurrent review services, eligibility verification, and claims' status review. Acts as Managed Care's representative for on-site educational sessions from Managed Care payors. This position is responsible for developing and maintaining on-line educational tools for Ballad Health users on a monthly basis.
This position manages the online contracting database (Sharepoint) for all of Ballad Health facilities which includes loading contracts in a timely manner and assisting with communicaition to internal customers.
This position manages the credentialing and network development issues with managed care payors for all Ballad Health facilities, including facility re-credentialing every 3 (three) years. Works closely with Integrated Solutions Health Network to ensure physicians are credentialed/enrolled in tandom with facility credentialing.
This position requires managed care contracting research and due diligence with payors as requested by internal customers. Responsible for documenting and communicating denial trends by payor on a monthly basis and addressing as needed with payors (excluding fee schedules and rates).
Responds to concerns of many and varied customers: patients, payors, contracting, credentialing, provider relations; Ballad Health Departments - Behavorial Health, Ballad Health Medical Associates, Patient Resource Management, Admitting/VIBES. Controls written or telephone managed care inquiries, including claims research resolution and response. Manages contract compliance issues from Ballad Health departments, including underpayments due to payor claims' systems issues and payor abuse of contract terms; manages payor operations meetings, and coordinates follow-up with Ballad Health departments with resolution to bring owed monies back as Ballad Health revenue. Actively participates on the monthly Ballad Health steering committee meetings to resolve issues.
RESPONSIBILITIES:
Facilitates Goodwill contract language review and ensures rate approvals are obtained from business owners during negotiations.
Addresses contract compliance issues from Ballad Health departments which includes underpayments.
Provides Ballad Health wide education related to Managed Care payors.
Interacts with front end staff (patient resource management, admitting, VIBES, CBO) regarding managed care issues.
Manages contract loading via. Sharepoint.
Ensures all online educational tools are updated on a monthly basis for Ballad Health customers.
REPORTING RELATIONSHIP
See Table of Organization.
EDUCATION AND EXPERIENCE
A four-year college degree preferred in Business with work experience in a related Healthcare field.
If no degree, 3-5 years' experience in a Facility Healthcare setting managing insurance follow up, or overseeing denial trends related to utilization management trends, or a working knowledge of payor contract execution to be able to identify areas of opportunity to increase contract performance and reimbursement.
If no degree, and doesn't have 3-5 specified experience must have 10 years' experience in Facility Healthcare office operations which includes knowledge of insurance eligibility, referrals, pre-certification, and medical necessity processes with payors.
Candidate must develop a plan to achieve HFMA certification or a Tennessee Insurance Producers License within 2 years of transitioning into the Contract Specialist III position.
Must have three to five years' experience in telephone response activity. Must demonstrate problem solving skills and communication skills. Must demonstrate the ability to work independently, set priorities, be flexible and organized, follow instructions, use effective time management, use good judgment in decision making, and complete assignments. Must demonstrate computer literacy in databases, spreadsheets, and word processing software and be proficient in general office equipment use. Must express ideas clearly, concisely, and logically, using both oral and written methods. Must value differences and diversity among customers. Must maintain confidentiality in patient, provider and payor issues.

Requirements
No additional requirements from any stated in the above description.