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Manager Professional & Alt Payment Network Contracting

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Location: Buffalo, NY, United States
Date Posted: Nov 2, 2019

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Job Description

Status: Full Time Facility: Administrative Regional Training Cntr

Work Schedule: Days Shift: 1:

Exempt from Overtime: Exempt: Yes FTE: 1.000000: Bargaining Unit: ACE Associates

Summary:

With an eye toward value based payment and population health management, the Manager Professional & Alternative Payment Network Contracting implements managed care strategies through facilitating and negotiating contracts and provisions for all Catholic Health professional services entities in conjunction with Catholic Medical Partners (CMP) as well as any agreements related to alternative payment models or value based reimbursement. The position ensures that contracts are operational and functional throughout the organization, collaborates to ensure payment accuracy, contract adherence and issue resolution with payers and internal stakeholders. This individual works with Catholic Health clinical leadership as well as payer representation on contractual and related items, including development of alternative payment models applicable to professional and home and community based care service areas. These functions include multidisciplinary interaction with various aspects of Catholic Health and Catholic Medical Partners as well as significant analysis and reporting functions related to the financial performance of payer contracts, inventive programs and related items. The Manager Professional & Alternative Payment Network Contracting will be responsible for ongoing communication throughout the organization related to managed care contracts and specific payer programs related to applicable ministries and maintaining strong relationships with the hospital and System Finance team, Revenue Management Team and Business owners of Catholic Health.

Responsibilities:

EDUCATION
  • Bachelor's degree minimum

EXPERIENCE
  • Three (3) to five (5) years managed care related experience required
  • Five (5) to ten (10) years healthcare experience preferred
  • Prior experience in professional, long term care, home care and/or DME preferred
  • Prior management experience preferred, but not required
  • Strong knowledge of healthcare reimbursement and billing practices preferred
  • Strong knowledge of risk/value based contracting and insurance negotiations preferred



KNOWLEDGE, SKILL AND ABILITY
  • Must be knowledgeable regarding managed care concepts, health care reimbursement, and financial analysis
  • Strong written and verbal communication skills required
  • Negotiation experience
  • Ability to take initiative in implementing new ideas, identify opportunities for improvement and to make innovative changes
  • Strong organizational skills
  • Proficiency in the use of technology (such as reporting tools, excel, word, power point and others)
  • Demonstrated strength in working with multidisciplinary teams

WORKING CONDITIONS
  • General office work, local travel, occasional early mornings and evenings required


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