Req #: 0000193987
Category: Leadership
Status: Full-Time
Shift: Day
Facility: RWJBarnabas Health Corporate Services
Department: Managed Care

ESSENTIAL FUNCTIONS:

• Negotiates contracts and subsequent rate amendments for RWJBH system entities
• Reviews and recommends managed care contract language and negotiates such language recommendations with health plans, and in accordance with legal provisions from office of General Counsel.
• Coordinates financial analyses for non-hospital entities working with CSH, joint venture partners (professional and ancillary) and the Medical Group.
• Is highly knowledgeable in contract structures, revenue cycle, and reimbursements/regulations for health system services including ayer policy requirements.
• Prepares and leads comprehensive financial impact analyses on actual and proposed contracts, with predominant focus on value based models.
• Maintains strong relationships with key managed care payers and resolves material contract compliance issues
• In working with RWJBH revenue cycle leadership and Joint venture partner relationships, where appropriate, installs internal and external procedures to ensure revenue stream safety net is in place.
• Reviews results of such efforts and implements sustainable process improvement to prevent revenue leakage and enhance revenue optimization.
• Works closely with other Managed Care team members and other company site/service line specific to execute strategic initiatives:
• Defensible pricing strategies.
• Innovative contracting solutions.
• Funding rate levels and contract operations improvements.
• Maintains strong working knowledge of leading insurance market and payer product platforms.
• Comprehensive understanding of varied reimbursement methodologies with predominant strength of fee-for-service structures and rates for health system entities.
• Demonstrates a deep understanding managed care contracting, billing, claims processing and collections Demonstrates strong skill in statistical analysis.
• Oversees contract management systems builds and maintenance for all RWJBH professional and ancillary entities.
• Includes daily report review and discussion with revenue cycle leadership teams to ensure the contract management system is correctly built.
• Reviews and ensure necessary Managed Care Team members are included in analytical analysis to determine if Materiality Breach has occurred and work with Payer to remedy.
• Prepares revenue forecasts for budgetary purposes for managed care payers, with a specialized focus on physician and other non-hospital entities.
• Coordinates the daily activities of the Payer Services staff as it relates to the processes for Children s Specialized Hospital Credentialing, Contract Management, and Charge and CSH Charge Master.
• Demonstrates exceptional communication skills with various internal and external partners/stakeholders, including insurance company negotiators, System management personnel, Physicians, and staff and management personnel in operational areas throughout the System (Credentialing, Legal, Revenue cycle, and Business Development).
• Works with site/entity directors to define, initiate, and direct operational reporting for the acute hospital sites including establishing goals and metrics.

OTHER DUTIES:

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.