GENERAL SUMMARY OF DUTIES
– Translates managed care contract terms and model relevant parameters in Contract Profiler and Calculator Model (CPCM) to ensure accurate discounts on patient accounts and proper reflection of expected net revenue.
DUTIES INCLUDE BUT ARE NOT LIMITED TO:
Coordinate managed care contract implementation activities with the Contract Negotiators, Payor Representatives and the Functional Managers within PAS
Liaison with PAS Functional Managers and Managed Care Negotiators and Payors to address managed care contract administration issues
Maintain and control managed care I-Plans in accordance with corporate standards and PAS procedures
Model managed care contract payment terms using CPCM (or other approved modeling tools)
Coordinate with IT&S Reimbursement Product Support for modeling of government or other contracts modeled directly in the Payment Calculator System
Publish and maintain Automated Quicksheets in the Contrack system for managed care contracts
Provide educational resources to support contract implementation and administration
PAS management meetings or facility contract management teams as necessary
Practice and adhere to the “Code of Conduct” philosophy and “Mission and Value Statement”
Other duties as assigned
KNOWLEDGE, SKILLS & ABILITIES
Communication - communicates clearly and concisely, verbally and in writing
Customer orientation - establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations
Interpersonal skills - able to work effectively with other employees, patients and external parties
PC skills - demonstrates proficiency in Microsoft Office applications and others as required
Policies & Procedures - demonstrates knowledge and understanding of organizational policies, procedures and systems
- able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly, spell correctly and transcribe accurately
Bachelor’s degree in Business, or Bachelor’s in another field with appropriate healthcare business experience
3-8 years medical finance, managed care contracting, or business office/claims shop operations experience
Excellent oral and written communication skills
Able to work independently and as a team member
Excellent PC skills
Excellent People skills
PHYSICAL DEMANDS/WORKING CONDITIONS
Requires eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment.
- Requires prolonged sitting, some bending, stooping and stretching.
Requires normal range of hearing and eyesight to record, prepare and communicate appropriate reports.
Requires lifting papers or boxes up to 25 pounds occasionally.
Work is performed in an office environment.
Work may be stressful at times.
Contact may involve dealing with angry or upset people. Staff must remain flexible and available to provide staffing assistance for any/all disaster or emergency situations.