WEEKEND REQUIREMENTS:

Not Specified

Knowledge, Skills, and Abilities

• Demonstrated analytical ability in a health related or contract negotiation environment.
• Excellent skills in verbal and written communication; excellent knowledge of Managed Care, Health Care Finance, Manage Care Contracts and Patient Accounting; experience in PC computer utilization for work processing, spreadsheet analysis and managerial skills.
• Additionally, the ability to develop and maintain good working relationships with payor executives is critical and prior experience is required

• QUALITY / CUSTOMER SERVICEMaintains systemwide service orientation to representatives of Sharp HealthCare entities, including hospitals and medical groups, through consistent assessment of needs and timely response to requests. Average customer overall satisfaction indicator, as measured through annual survey, to equal or exceed ‘satisfied’ scale measure.Develop and maintain relationships with payer executives in support of the Sharp HealthCare mission, values and philosophy, and ensure timely response to contractual issues and contract compliance problems. Collaborate with key individuals to align contracting strategies with organizational mission and financial objectives.Evaluate contract language and provide financial and statistical analysis, with the goal of development like kind reporting across the system, for contract analysis and budget development. Maximize reimbursement and minimize financial risk and legal issues.Negotiate contracts in accordance with each entities desired reimbursement goals.
• STRATEGIC LEADERSHIPDevelop and implement payer strategy, building and maintaining payer relationships, and negotiate contracts to further drive a clear and effective reimbursement approach. Develop a direction and formulate long-term, sustainable goals for both commercial and government payers.Develop and maintain communication links throughout the system to identify payer issues and the development of action items for resolution. In addition, communicate current contract information, address contract issues and work with both hospital and medical group executive leadership to identify system-wide contracting objectives. Satisfaction indicator to be measured to equal or exceed ‘satisfied’.Effectively participates with and/or provides support in the design, review, development and implementation of new programs. Efficiently allocate resources to meet or exceed time expectations for these projects at least 85% to 95% of the time.Works in conjunction with staff to design and implement contract reimbursement modeling and analysis used in contract renegotiation and to ensure correct reimbursements. Successfully completes analysis and submits initial proposal within renegotiation time frames 80% to 85% of the time.Stay informed on emerging payer trends, reimbursement methodologies, regulatory issues, plan benefits, payer activity, and market competition. Utilize this information in concert with current payer mix and future market projections to develop and maintain growth strategies. Ensure that contracts optimize pricing and align hospital and physician incentives.
• SYSTEMS INTEGRATIONAssure appropriate parties are informed of contractual modifications and new or terminated contracts. Work with Managed Care Operations, hospital and medical group organizations divisions to ensure systems are accurate for claim pricing and claims payment. Work towards system initiates to improve efficiency through integration.Serve as an executive liaison, and maintain effective operational linkages to Business Development, Finance, and Revenue Cycle teams.
• EMPLOYMENT MANAGEMENTRecruit, lead and develop personnel involved in payer strategy, payer contracting and Managed Care finance. Hold quarterly ‘all staff’ meetings with all departments, as well as monthly Contracts department staff meetings to provided information on upcoming projects, review status reports on current projects, share contracting priorities and objectives and address annual Employees Engagement Survey. Practices safe working habits.

Knowledge, Skills, and Abilities

• Demonstrated analytical ability in a health related or contract negotiation environment.
• Excellent skills in verbal and written communication; excellent knowledge of Managed Care, Health Care Finance, Manage Care Contracts and Patient Accounting; experience in PC computer utilization for work processing, spreadsheet analysis and managerial skills.
• Additionally, the ability to develop and maintain good working relationships with payor executives is critical and prior experience is required.

Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected clas