Scope of Position: The Managed Care Department is responsible for developing and implementing the managed care strategies and objectives for the OSU Health System University Hospitals, The James, University Reference Labs and related entities (OSUHS). The department negotiates and manages agreements with managed care organizations and pursues initiatives related to improve OSUHSs ability to compete in a managed care environment. The Department coordinates all aspects of managed care contracting for the following entities: University Hospitals and the James (Hospitals); University Reference Laboratories (Ancillary Providers), Harding Behavioral Healthcare, Talbot Substance Abuse Healthcare and other entities as may be established by OSUHS. Additional responsibilities of payor relations and contract implementation that include managing and providing leadership to the various managed care operational and implementation activities within the OSUHS. The Managed Care department functions as a team in accordance with OSUHS's strategic plan and departmental objectives.
Position Summary: The Senior Contract Specialist provides support in negotiating and managing agreements with designated managed care organizations and international insurance companies on behalf of OSUHS and related entities. Agreements may be RVU based reimbursement, DRG based, % of billed charges, per diem and possibly service specific (i.e. limited to cardiovascular services) or general in nature. The Senior Contract Specialist must participate in and prioritize multiple negotiations at one time to ensure the successful implementation of new agreements. The Senior Contract Specialist is part of all phases of the negotiation process and ensuring resolution to any issues that arise during the contract term.
Typical activities include financial analysis and/or development of proposed reimbursement terms, rate modeling, reimbursement and contract negotiation, trouble-shooting contract issues and responding to requests for information/proposal. This includes ensuring Hospital departments understand their roles and responsibilities in achieving overall contract compliance, working with Hospital departments to improve contract compliance, identifying and facilitating the implementation of OSUHS and Payor process changes that will improve the revenue cycle, working closely with the Central Business Office on claims payment issues and coordinating activities with staff in the Medical Center. This position works with the department to manage and maintain the departmental database on an ongoing basis and identifies and implements opportunities to improve it.
Required Qualifications: BS in business, marketing or healthcare; masters preferred.
Minimum 4 yrs experience in managed care preferably network development/contracting.
Strong verbal/written communication skills.
Comprehension of healthcare issues to effectively deal with administration, hospital, physician practice personnel and managed care organizations.
Experience with fee for service, DRG amp; RVU reimbursement, % of billed charges and per diem methodologies.
Strong negotiation, analytical amp; organizational skills.
Ability to work under stress and deadlines, cope with frequent interruptions and prioritize.
Knowledge of healthcare terminology and reimbursement methods.
Familiarity with quality assurance and utilization review standards.
Proficiency with MS Office suite
Our Comprehensive Employee Benefits Include: An array of retirement plan options, each with a generous employer contribution.
Affordable health insurance options, including dental, vision and prescription coverage that begin on day one.
Paid vacation and sick leave, including short and long-term disability and paid parental leave.
Get the most out of the Public Service Loan Forgiveness program.
And much more!
