Job Summary: 

• Use resources available to actively research and select key strategic customers, identify customer and client needs
• Generate strategic plans and propose tailored solutions to address the needs of and prioritize prospects that enhance the regional territory.
• Identify customer financial trends and manage stabilization, facilitating discussion with customers and billing.
• Identify the depth and maturity of existing client services relationships and develop plans to improve over time
• Develop direct relationships with sales management, operations, and billing.
• Establish yourself as a market leader who can help identify and fix challenges
• Build and oversee all relationships within assigned customer accounts
• Facilitate the resolution of problem customer issues utilizing personal contacts, negotiations, and problem-solving skills
• Manage contracting, including developing negotiation strategies, gathering data for negotiations, and participating in negotiations to achieve the company's objectives
• Provides leadership and subject matter expertise within the company on the changing healthcare dynamics and the needs of the company's customers and clients.
• Proactively share best practices across internal and external functions
• Work with customers to facilitate streamlined reimbursement for the company
• Facilitates communication, implementation, and maintenance of managed care policies, procedures, and objectives
• Provides customer information and data to management and sales to ensure overall marketing effectiveness.
• Participate in strategy development for the team and lead customer strategy for assigned accounts in company meetings.
• Provide direction needed by staff to interface effectively with internal staff, providers, payors, and health plans in negotiations, problem resolution, and dispute management.
• Ensure that contracting, payor relations, and provider services staff develop positive, effective relationships with internal and external customers.

Skills on Resume: 

• Strategic Planning (Hard Skills)  
• Client Relationship Management (Soft Skills)  
• Contract Negotiation (Hard Skills)  
• Healthcare Market Knowledge (Hard Skills)  
• Problem Solving (Soft Skills)  
• Cross-functional Collaboration (Soft Skills)  
• Reimbursement Strategy (Hard Skills)  
• Communication Skills (Soft Skills)

Job Summary: 

• Pitch and sell company services utilizing a structured sales process
• Effectively work with healthcare professionals, institutions, community agencies, trade associations, and manufacturers to promote the company's value proposition
• Solicit, negotiate, implement, and maintain long-term referral-generating relationships
• Convert current and new customer sources into a progressively growing referral and revenue base
• Maintain customer relations, identify their issues, and develop creative solutions
• Organize and prioritize time and schedules to maximize exposure to key customers
• Attend trade shows, conferences, association meetings, and educational seminars
• Plan, develop, and implement annual business strategy plans.
• Report to the CEO and Board of Directors regularly on the progress of said business plans.
• Participate in marketing presentations and/or customer meetings.
• In conjunction with the Chief Medical Officer (CMO), review, analyze, and monitor the cost-effectiveness of utilization programs/services.
• Manage all government relations and public relations activities in collaboration with the Compliance Officer.
• DMC meets with the Director of Marketing and Sales to increase revenue and enrollment and achieve financial performance targets.
• Assist the CEO in negotiating and implementing contracts with the State and other entities.
• Represent the CEO at various trade associations and industry meetings.

Skills on Resume: 

• Sales Strategy (Hard Skills)  
• Client Engagement (Soft Skills)  
• Relationship Management (Soft Skills)  
• Referral Development (Hard Skills)  
• Time Management (Soft Skills)  
• Business Planning (Hard Skills)  
• Public Relations (Soft Skills)  
• Contract Implementation (Hard Skills)

Job Summary: 

• Manage all components of the contract negotiation process.
• Identify the key players in new markets into which the Company enters
• Lead the rate and language negotiation discussions with the payers
• Work with the Executive Director and Director of Finance to ensure negotiated rates are acceptable and will add value
• Develop professional relationships with contracted payers.
• Works with the Company's Billing Department to discuss/resolve claim issues resulting from contract interpretation and/or language
• Monitoring changes in payer policies affecting reimbursement or administration, and any emerging payer concerns.
• Keeping up-to-date on marketplace changes for payers, networks, reimbursement issues, and changes in guidelines
• Oversee the process of health plan enrollment/credentialing applications for facilities and licensed providers with all health plans.
• Ensure that all payer contracts are renewed before expiration
• Oversee the process of health plan enrollment/credentialing applications for facilities and licensed providers with all government and commercial health plans.
• Review weekly reports from the credentialing database/tracking tools to ensure credentialing staff have (1) prioritized the required follow-up with licensed providers and health plans
• Update action notes to maintain an accurate record of progress with health plans.
• Oversee the credentialing staff's efforts to ensure that all payor contracts are renewed before expiration.
• Structure, hire, lead, and develop a team focused on the managed markets business with the intent of delivering broad payer coverage while exceeding revenue goals
• Ensure compliance with Medicare and Medicaid guidelines and other managed care policies

Skills on Resume: 

• Contract Management (Hard Skills)  
• Payer Relations (Soft Skills)  
• Rate Negotiation (Hard Skills)  
• Policy Monitoring (Hard Skills)  
• Credentialing Oversight (Hard Skills)  
• Claims Resolution (Soft Skills)  
• Team Development (Soft Skills)  
• Regulatory Compliance (Hard Skills)

Job Summary: 

• Direct all contracting activities for the enterprise-wide payor contract portfolio.
• Direct contracting staff activities to achieve optimal contract financial and operational outcomes as well as effective contract management.
• Responsible for contract negotiations, including rates, payment methodologies, contract language, and value-based payment programs, by internal control processes for contract review, approval and signature.
• Ensure contracts are negotiated within established parameters and acceptable time frames for maximum performance.
• Make recommendations for contract strategies and oversee the activities of the Provider Enrollment staff.
• Oversee the activities of the Provider Enrollment team to ensure timely and accurate enrollment of facilities and employed providers with contracted payers.
• Ensure compliance with credentialing, delegated credentialing requirements related to Provider Enrollment.
• Monitor and update provider demographic information.
• Educate network providers and staff on key managed care principles, market trends, and opportunities for improvement in support of enterprise goals and objectives
• Prepare and provide training on pertinent subject matter to network providers.
• Communicate and educate operational areas on contract changes, policy updates, etc.
• Ensure staff have the information needed to successfully implement and operationalize agreements.
• Coordinate and lead activities using a collaborative and team approach.
• Handle multiple projects and ensure teams perform under tight deadlines with a focus on effective implementation, communication, and follow-up.
• Maintain collaborative, team relationships with peers and colleagues to effectively contribute to the working group`s achievement of goals and to help foster a positive work environment.

Skills on Resume: 

• Contract Negotiation (Hard Skills)  
• Project Management (Hard Skills)  
• Team Leadership (Soft Skills)  
• Credentialing Compliance (Hard Skills)  
• Provider Enrollment Oversight (Hard Skills)  
• Interpersonal Communication (Soft Skills)  
• Education Delivery (Soft Skills)  
• Attention to Detail (Soft Skills)

Job Summary: 

• Provide managed care support and expertise by attending scheduled meetings with operations leadership, including Division/Market/Practice operations management and Acquisitions and Development teams.
• Develop and implement, in conjunction with the target market, the contracting plan for acquired assets and a managed care strategic plan for post-closure.
• Direct and coordinate the managed care contract negotiation process for designated Division/Market/Practice Management related to targeted acquisitions
• Oversee individual practice managed care contracting efforts and/or contract evaluation as directed
• Analyze and estimate the financial impact of managed care contracts by operations management for Division/Market/Practice and/or for the target market, acquiring a new entity
• Attend all Due Diligence, Acquisition planning, and post-acquisition meetings
• Coordinate significant managed care analysis and activities with PHO/IPA operators and managed care operations management, evaluate PHO/IPA/ACO contracts as part of an acquisition strategy
• Oversee the due diligence process related to all payer activity in connection with acquisitions
• Maintain a permanent record of all major payer contracts associated with pre- and post-evaluation of acquisitions
• Administer protocols to ensure smooth and timely implementation and evaluation of possible acquisitions and contract terms related to assigned acquisitions
• Prepare monthly reports to summarize managed care activities/acquisition activity across the company
• Analyze performance and provide evaluation on all existing contracts and anticipated post-acquisition performance
• Design and direct projects as requested by leadership
• Administer the company’s guidelines for managed care contracting, due diligence, and compliance
• Maintain knowledge of state and federal legislative and regulatory laws and rules regarding managed care

Skills on Resume: 

• Contract Management (Hard Skills)  
• Strategic Planning (Hard Skills)  
• Financial Analysis (Hard Skills)  
• Regulatory Compliance (Hard Skills)  
• Acquisition Support (Hard Skills)  
• Cross-functional Collaboration (Soft Skills)  
• Performance Evaluation (Hard Skills)  
• Project Leadership (Soft Skills)

Job Summary: 

• Oversee the DCE (Direct Contracting Entities), MA (Medicare Advantage) plan, Care Management, and Credentialing Departments
• Responsible for administrative contracting, delegation, and the day-to-day management and operations of the organization, including oversight of claims payment
• Enrollment processing and member service operations, grievance and appeal operations, pharmacy management, and analytics
• Information technology, revenue management, and compliance monitoring and auditing.
• Directs intra- and inter-departmental activities related to the implementation of internal business operational processes.
• As well as ongoing management of information system maintenance, enhancements, new software releases, and interfaces.
• Responsible for the design, maintenance, and improvement/reengineering of business structure, business workflow processes, and/or configuration and integrity of computer programs/systems supporting business operations.
• Serve as an internal consultant on matters relating to decision support, data analysis, and system functionality, assisting in optimizing relations with vendors and providers.
• Routinely identify trends and inform the CEO of sensitive issues and/or problem areas in the plan’s dealings with vendors or providers.
• Recommend and implement corrective actions
• Assist in the negotiation of vendor contracts.
• Oversee the Director of Network Management’s provider contracting activities and network optimization.
• Schedule and conduct meetings with the Committees of the Board of Directors as specified and necessary.
• Direct the workforce to meet strategic goals as determined by the CEO and approved by the Board of Directors.
• Manage and evaluate employees directly reporting to this position.

Skills on Resume: 

• Operational Oversight (Hard Skills)  
• System Optimization (Hard Skills)  
• Vendor Management (Hard Skills)  
• Business Process (Hard Skills)  
• Data Analysis (Hard Skills)  
• Team Leadership (Soft Skills)  
• Contract Negotiation (Hard Skills)  
• Strategic Execution (Soft Skills)

Job Summary: 

• Develop a plan and implement strategies for payer engagement, contract management, and negotiations.
• Assess and make recommendations to improve the efficiency of the current process for contract development and implementation
• Keep abreast and disseminate pertinent regulatory and insurance-related information to promote timely and efficient billing of all inpatient, outpatient, and ancillary services
• Build and maintain relationships with key third-party stakeholders to enable strong negotiating results and optimal payer revenue growth
• Negotiate contract agreements/reimbursement rates
• Provide proactive and responsive communication to payers, senior leadership, and administrators
• Analyze and review monthly results for risk against annual plan and forecast projections, providing variance explanations/recommendations
• Provide financial support in the completion of monthly system reporting
• Provide servant leadership to a team of dedicated professionals to contribute to the continued success and growth of the function and organization, and provide mentoring for career development.
• Fosters a success-oriented, accountable environment within the company.
• Represents the firm with payor clients, healthcare policymakers, legislators, physician organizations, patient advocates, and other key stakeholders that make or influence reimbursement decisions.
• Expand medical policy to match the pace of product innovation
• Work cross-functionally to develop and implement a value-based/outcome-based contracting strategy with payers
• Work collaboratively with counterparts, including sales leaders, customer success, medical affairs, market access, billing, legal, finance, product development, and marketing, on strategic business development efforts to ensure coverage, access, and reimbursement of products

Skills on Resume: 

• Payer Engagement (Hard Skills)  
• Contract Negotiation (Hard Skills)  
• Regulatory Knowledge (Hard Skills)  
• Stakeholder Management (Soft Skills)  
• Financial Analysis (Hard Skills)  
• Team Leadership (Soft Skills)  
• Strategic Collaboration (Soft Skills)  
• Value Contracting (Hard Skills)

Job Summary: 

• Distribute new contracts and information about new products to key staff members and the teams that are loading contracts into computer systems.
• Participate in activities that result in improved contract performance, which include performing performance analysis and communicating with all Revenue Cycle teams.
• Participate and/or facilitate regular meetings with key payors to ensure continuing contract performance
• Identify payor issues affecting payment or operations, discuss/ resolve claim issues resulting from contract interpretation and/or language, and assist hospital staff in developing relationships with payors.
• Meet regularly with the Business Office and facility CFOs to discuss payor issues, changes in the health system business, changes in payor policies affecting reimbursement or administration, and any emerging payor concerns before incurring high-dollar losses.
• Communicate chargemaster changes to payors and monitor responses and rate adjustments under the agreements.
• Negotiate with each affected payor the correct financial adjustments and then notify internal departments of final changes and the effective date of such changes for contracts.
• Work with the Ardent team of contract modeling staff to communicate contract terms and modeling scenarios during negotiations.
• Interpret reports on proposals and counter-proposals.
• Provide tools and information to enhance the Managed Care Department’s resources for contract language, reimbursement negotiation, and overall knowledge of managed care.
• Evolve managed care department processes, maintain, and revise to promote greater efficiency within the department.
• Upon completion of contract negotiation or a managed care project, prepare reports to communicate contract or project results.
• Prepare an Executive Contract Summary report, consisting of contract provisions and financial analysis.
• Seek internal approvals as required by company policy.
• Ensure that dually signed agreements are received by the organization and filed in contract management systems
• Prepare reports, such as payor comparisons or regarding specific payor contact information, at the request of Ardent’s corporate office or upon request by hospital leadership.

Skills on Resume: 

• Contract Distribution (Hard Skills)  
• Payor Analysis (Hard Skills)  
• Issue Resolution (Soft Skills)  
• Rate Negotiation (Hard Skills)  
• Report Preparation (Hard Skills)  
• Process Improvement (Soft Skills)  
• Team Communication (Soft Skills)  
• Data Interpretation (Hard Skills)

Job Summary: 

• Support relationships between healthcare payers and the IPA and resolve issues related to credentialing, managed care participation, claims payment, demographic changes, referrals, and accessibility
• Analyze all managed care contracting, including value-based contracts and deliverables, working collaboratively with the Director of Population Health.
• Manage and maintain accurate network files for each pending and executed managed care contract and provide network updates to the payers and working IPA providers to confirm the accuracy of reports.
• Support and track the development and submission of applications for new managed care contracts and value-based initiatives, working to obtain stakeholder and governance input and providing management and oversight on relevant deliverables.
• Review reports provided by payers related to both financial and quality performance, and develop summary reports on performance for IPA leadership and governance committees, flagging areas of concern.
• In collaboration with members of the IPA analytics and finance teams, help design and distribute risk/shared savings among network participants in various VBP programs.
• Define critical implementation or performance improvement initiatives for managed care contracting and VBP programs, and support the implementation process within the IPA
• Analyze network adequacy and network leakage data, and identify opportunities for continuous improvement across the clinically integrated network.
• Develop written and verbal reports on areas related to managed care contracting, VBP, sustainability, and clinical integration.
• Assist providers with initiatives related to EDI, access and availability, and quality, including gathering information to comply with HEDIS.
• Assist providers with the implementation of electronic medical record conversions.
• Ensure managed care/revenue cycle coordination among all functional areas required to maximize contact performance (e.g., business office, managed care, UM, and CFO staff).
• Facilitate meetings of corporate and field staff to establish parameters that ensure contract performance objectives and the establishment of managed care/revenue cycle committees at all facilities with significant managed care business volume.
• Strengthen managed care analytical reporting to improve negotiations, goal setting, and maximizing contract performance.

Skills on Resume: 

• Payer Relations (Soft Skills)  
• Contract Analysis (Hard Skills)  
• Data Management (Hard Skills)  
• Performance Reporting (Hard Skills)  
• Value Contracting (Hard Skills)  
• Network Optimization (Hard Skills)  
• Process Improvement (Soft Skills)  
• Stakeholder Coordination (Soft Skills)

Job Summary: 

• Produce new business and assist in the development of sales and marketing strategy designed to cultivate revenue generation opportunities, with a specific focus on Healthcare/Managed Care
• Develop comprehensive new business sales and development plans for targeted prospects/clients
• Support the Healthcare/Managed Care team to positively impact growth and profitability
• Working with clients and markets to support their long-term risk, capital, and growth strategies
• Improve existing Healthcare/Managed Care products/services, and develop new ones
• Collaborating with broking teams across solution lines to develop new business and build client/prospect relationships, with a specific focus on the Healthcare Vertical
• Lead the development of a compelling product vision and strategy for Managed Care and Care Management solutions.
• Drive product insights, roadmap prioritization, and resource allocation.
• Work closely with cross-functional leaders across all strategic and product areas of Gain-well to gain buy-in, forge partnerships, and build enthusiasm for the product vision.
• Grow and develop a high-performing product team, attract, grow, and retain talent.
• Develop and lead a disciplined product development process.
• Establish a go-to-market strategy for the product line, including potential direct and indirect monetization strategies.
• Play a key role in managing relationships for network hospitals, physicians, ancillary providers, and vendors related to managed care agreements.
• Maximize the performance of UHS-managed care contracted business through sound health care and fiscal management practices.
• Establish contracting parameters, “rules of engagement”, and contracting tools to ensure the creation of managed care contracts that meet UHS corporate financial goals and maximize the potential for revenue collection per company systems.

Skills on Resume: 

• Business Development (Hard Skills)  
• Sales Strategy (Hard Skills)  
• Product Management (Hard Skills)  
• Team Leadership (Soft Skills)  
• Client Relations (Soft Skills)  
• Market Analysis (Hard Skills)  
• Contract Strategy (Hard Skills)  
• Cross-functional Collaboration (Soft Skills)

Job Summary: 

• Oversee the strategic development of Managed Care, IPA, and Payor Contracts on a national, regional, and local level for multiple lines of business, including commercial and governmental products.
• Provide support and expertise to contract managers in developing and analyzing large and complex data sets for the creation of financial rate models
• Make proposal recommendations in negotiating/renegotiating, and implementing rates and terms for health plan contracts
• Ensure key operational and financial budget objectives are met.
• Lead, develop, and identify negotiation strategies for value-based contract negotiations with payors, while working collaboratively with internal key stakeholders to execute and manage such arrangements.
• Review and evaluate contract language and reimbursement terms in existing and potential managed care agreements, and make recommendations and execute any modifications required for the benefit of the organization.
• Cultivate relationships and maintain strong communications with health plans and payor contacts.
• Prepare financial reports to review and assess utilization trends and overall financial performance of contracts, and identify improvement opportunities with rates/contract language, with the development of action plans to carry out improvements.
• Establish performance expectations and provide staff coaching to achieve positive results.
• Recognize effective performance, and address performance needing improvement in an honest and timely manner.
• Secure support for negotiation goals and positions with both internal and external constituents through strong and effective persuasive skills and technical knowledge.
• Monitor, interpret, evaluate, and report on changes in payor performance, market trends, healthcare delivery systems, and legislative initiatives that impact managed care efforts (e.g., CMS, State DFS, Health Care Reform, etc.) and provide recommendations to adapt to a changing health care industry.
• Negotiate local, regional, and national managed care contracts with leading managed care organizations and other third-party payers
• Participate in payer negotiations as appropriate and requested by the facility CEO and Regional VPs.
• Represent UHS to payers on a national basis to encourage open communication and maintain relationships beneficial to UHS.

Skills on Resume: 

• Contract Strategy (Hard Skills)  
• Data Analysis (Hard Skills)  
• Rate Negotiation (Hard Skills)  
• Budget Management (Hard Skills)  
• Value Contracting (Hard Skills)  
• Stakeholder Communication (Soft Skills)  
• Performance Coaching (Soft Skills)  
• Market Evaluation (Hard Skills)

Job Summary: 

• Monitor and plan for contract renewals and budget increases, and ensure that all renewals are completed.
• Assist the hospital system CFO’s with budgeting for payor increases annually.
• Have market awareness of changes in payor products, payor policies, and state regulatory and industry trends.
• Communicate and be a resource for information about contract terms, managed care department projects, payor processes, revenue cycle inquiries, and to facilitate the resolution of complex issues that arise from time to time.
• Work effectively with Ardent analysis resources to ensure that contract renewals are modeled for financial impact.
• Responsible for communications with third-party payors regarding updates to the health system, including changes in locations, additions, or other material system changes that will impact payor contracts and reimbursement.
• Facilitate regular communications and claims payment problem-solving when the business office needs additional support.
• Support the contracting needs of the Patient Quality Alliance CIN network in Idaho and the ACO initiatives of the Topeka Physicians Group in Kansas.
• Manage all components of the contract negotiation process for a directly negotiated contract.
• Assist JV partners with payor negotiations on behalf of JV facilities and physician entities.
• Determine financial and administrative objectives, analyze financial reports, negotiate or assist with negotiations of rates and language, follow internal approval processes for contracts, and implement final contracts for all commercial, Medicare, governmental, and other third-party payors.
• Work closely with Ardent VP of Managed Care, hospital and medical group CEOs/CFOs, and JV Partner staff to identify and implement contracting opportunities for revenue improvement and administrative efficiency.
• Accountable for developing productive and professional relationships with contracted payors that reimburse America’s Division entities and physicians.
• Identify opportunities with payors to acquire premier provider designations for hospital entities and physicians.
• Seek opportunities for new patient volumes through payor initiatives.
• Communicate with hospital staff to ensure that all contracts and amendments are loaded into the contract database.

Skills on Resume: 

• Contract Renewal (Hard Skills)  
• Budget Planning (Hard Skills)  
• Market Awareness (Hard Skills)  
• Issue Resolution (Soft Skills)  
• Financial Modeling (Hard Skills)  
• Payor Communication (Soft Skills)  
• Contract Implementation (Hard Skills)  
• Relationship Management (Soft Skills)