Managed Care Contract Manager – Orlando, FL

orlando-health-logoPosition Summary

Responsible for the daily management and administration of Orlando Health hospital and physician contracts with minor managed care payors. Negotiates contracts, monitors compliance, identifies areas of opportunity, and takes appropriate action.

Essential Functions

  • Responsible for building business relationships and representing Orlando Health to external health care organizations, i.e. Commercial, Medicare, and Medicaid Managed Care plans; state agencies, such as Agency for Health Care Administration (AHCA); federal agencies such as Centers for Medicare and Medicaid Services (CMS); community-based employers; and third party administrators.
  • Participates with management in the total contract negotiation process, including: contractual language review and modifications in accordance with Florida Statutes and Orlando Health policy, and negotiation of reimbursement methodology and financial terms in accordance with Orlando Health financial goals and objectives.
  • Negotiates individual letters of agreement on behalf of Orlando Health with managed care plans for which physicians and/or hospitals are not contracted.
  • Works with Managed Care financial analysts to develop and validate financial models needed to assess reimbursement opportunities presented during contract negotiations.
  • Works with hospital Patient Accounting and physician Central Business Office to monitor accounts receivable, identify trends, and develop processes for resolution, implementation, and ongoing evaluation. Secures resolution of outstanding accounts receivable through contract relationships with managed care plans.
  • Coordinates and leads monthly operations meetings with contracted managed care payors whereby outstanding credentialing, accounts receivable, and other operational issues are addressed. Takes ownership and/or coordinates with appropriate Orlando Health team members and managed care plan contacts to ensure prompt resolution of identified issues.
  • Ensure entire Orlando Health system is appraised of necessary details for each plan, including physician effective dates, managed care plan policies and procedures, contract terms and reimbursement, and other relevant information.
  • Reviews and updates new fee schedules from managed care plans, and communicates new schedules to revenue cycle teams responsible for loading and testing rates.
  • Conducts research, prepares analysis, and makes recommendations to management related to employed physician initiatives.
  • Serves, on an ongoing basis, as liaison between Orlando Health physician practices and affiliated entities with both contracted as well as non-contracted organizations. Functions as resource to internal staff by providing direction for handling of situations that arise regarding members of managed care plans seeking services at Orlando Health.
  • Manages priorities and is flexible to ensure deadlines are met.
  • Maintains reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA, and other federal, state, and local standards.
  • Maintains compliance with all Orlando Health policies and procedures.

Other Related Functions

  • Works as a team player in facilitating efficient and effective assistance to colleagues throughout the Orlando Health system.
  • Assists physicians and others as needed with all matters relative to managed care.
  • Keeps abreast of legislative changes affecting Orlando Health.
  • Maintains confidentiality.
  • Assumes responsibility for professional growth and development.

Education/Training

  • Bachelor’s degree in healthcare administration, business administration, finance, or closely related field.

Licensure/Certification

  • None

Experience

Two (2) years in managed care contract negotiations, health plan operations, or physician practice management. Proficient in Microsoft Windows including Excel and Word.

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