JOB SUMMARY

Reporting to the CFO, the Contract Manager is accountable for all third-party payor contracting and financial analysis. Responsibilities include but are not limited to the following: Responsible for the oversight of the contracting functions for the medical group and ancillary contracting. Serves as a resource for internal education on contracts and managed care systems. Negotiate to minimize financial risk and legal issues, while communicating contractual terms to ensure smooth administration of contracts. Provide support through contract analysis, consultation in new program development and assist in contract reimbursement modeling for the annual budgeting process. Also responsible for contract reviews with emphasis on assuring that Rate Sheets are financially sound and inclusive of all relative financial terms and contracted payment factors (Revenue Codes, CPT Codes, etc.) Develop and manage projects as a result of legislation changes or updates. Responsible for operational support system to respond to contract informational needs and monitor facility issues regarding contracting priorities. Develops skills and provides focus on the market conditions/changes including but not limited to consumerism, value-based healthcare, transparency, risk contracting, etc. and how these changes or trends affect PHMG financially. Works in collaboration with Revenue Cycle and Utilization Management to ensure organizational strategy is met.
Ability to speak and read English at a level that is sufficient to satisfactorily perform the essential functions of the position. Knowledge of standard office equipment (i.e., calculator, fax, photocopier) and personal computer and computer software skills (i.e., MS Windows, Excel, Access, Word, PowerPoint, internet, e-mail). Windows computer skills including proficient use of keyboarding, use of mouse or keys for functions such as selecting items, use of drop-down menus, scroll bars, opening folders, copying and similar operations required upon employment or within the 1st two weeks of employment to perform the essential functions of the job. Performs other duties as assigned. Follows Palomar Health Medical Group rules, policies, procedures, applicable laws, and standards. Carries out the mission, vision, and quality commitment of Palomar Health Medical Group.

JOB REQUIREMENTS

Minimum Education: Bachelor’s Degree in accounting, finance, business administration, healthcare or related field.
Preferred Education: Master’s Degree
Minimum Experience: 2 years of Third-Party Payor Contracting
Preferred Experience: 2+ years Managed Care
Required License: Valid Driver’s License
Preferred License: Not Applicable
Required Certification: Not Applicable
Preferred Certification: Not Applicabl

Please refer the Job description for details