Managed Care Contract Specialist - SCG HEALTHCARE STAFFING

PRINCIPAL ACCOUNTABILITIES

• Accurately loads, tests, and maintains executed hospital contracts in the contract modeling system, which subsequently flows into System financial adjustments, netting accounts receivable at the time of billing.
  
• Performs prospective modeling of proposed contracts, rate structure/value scenarios, and other reimbursement changes to support payer negotiations in addition to daily operations.
  
• Analyze and determine the financial impact of government (federal and state) and commercial fee schedule/reimbursement changes to develop proposed adjustments (what-if scenarios) to support negotiations.
  
• Loads and maintains hospital contract reimbursement and terms in an internal database for applicable user and vendor accessibility.
  
• Generates standard and ad-hoc reporting allowing for critical decision-making specific to hospital reimbursement and associated impacts.
  
• Supports Managed Care Contract Administrators with identification of opportunities, risks, errors, etc. in payer reimbursement proposals and counter-proposals for comprehensive value review and accuracy.
  
• Serves as a Subject Matter Expert (SME) in conjunction with the Managed Care Contract Administrator relevant to facility and/or professional contract reimbursement.
  
• Collaborates with the Revenue Cycle, Finance, Government Reporting, and various other internal stakeholder departments to address contract variances and discrepancies, and contributes as appropriate in other third-party payer contract reimbursement-related projects. 
  
• Works collaboratively with external System vendors regarding contract audit activities and various third-party payer reimbursement-related matters.
  
• Identifies potential process improvement opportunities, initiating projects to improve internal operations.
  
• Ensures safe care to patients, staff, and visitors; adheres to hospital policies, procedures, and standards within budgetary specifications including time management, supply management, productivity, and quality of service.
  
• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals that contribute to the success of the organization; serves as preceptor, mentor, and resource to less experienced staff.
  
• Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann’s service standards by providing safe, caring, personalized, and efficient experiences to patients and our workforce. 
  
• Other duties as assigned.
  

Requirements

MINIMUM QUALIFICATIONS

Education: A bachelor’s degree in business administration, finance, or accounting is preferred.

Licenses/Certifications: Required to complete training and become certified in the applicable EPIC applications within the first 90 days of employment, including Resolute Hospital Billing Expected Reimbursement Contracts Administration.

Experience / Knowledge / Skills:

• Three (3) years experience in hospital contract modeling required (preferably in Payment Integrity Compass (PIC) or Epic).
  
• Effective oral and written communication skills.
  
• Ability to analyze, problem-solve, and apply critical thinking in a fast-paced environment.
  
• Strong organizational skills with the competency to work independently and as part of a team, and prioritize responsibilities.
  
• Must possess proficient Excel skills (i.e. pivots, v-lookup functions).