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Overview

Catholic Health is one of Long Island’s finest health and human services agencies. Our health system has over 16,000 employees, six acute care hospitals, three nursing homes, a home health service, hospice and a network of physician practices across the island.

At Catholic Health, our primary focus is the way we treat and serve our communities. We work collaboratively to provide compassionate care and utilize evidence based practice to improve outcomes – to every patient, every time.

We are committed to caring for Long Island. Be a part of our team of healthcare heroes and discover why Catholic Health was named Long Island's Top Workplace!

Job Details

This position reports to the Vice President of Managed Care and is responsible for processing complex hospital, provider, continuing care and ancillary contracts with a wide variety of managed care organizations and third party payers. This position will have 1 direct report

Primary Duties:

+ Serves as expert resource to internal and external parties with regards to managed care contract terms, interpretation, implementation, and maintenance.

+ Manages day to day activities of one staff member

+ Responsible for the escalation of accounts receivable issues to health plan leadership.

+ Negotiates reimbursement terms for both facility as well as professional services.

+ Distributes all new Agreements and Amendments and supports Epic Contract Management team as negotiated terms are loaded into the system.

+ Coordinates Joint Operating Committees with assigned payers.

+ Coordinates payer educational sessions as needed.

+ Participates in payer resolution meetings with the staff in the Revenue Cycle Department.

+ Reviews payment discrepancy analysis with Revenue Cycle team and troubleshoots complex payer behavior for resolution.

+ Establishes rapport and maintains working relationships with current and potential managed care organizations.

+ Responsible for system wide contract education including monthly plan policy updates and newsletter distributions, updates to payer summaries, maintenance of hard copy and electronic files, spreadsheets, databases, etc.

+ Works with Joint Venture Ambulatory Surgery Centers

Secondary Duties :

+ Performs miscellaneous job-related duties as assigned.

Requirements:

+ Knowledge and Experience - Experience with the third party payer contract negotiation process. Strong background in developing provider reimbursement rates and knowledge of Medicare and Managed Care reimbursement rates to all provider types. Knowledge of managed care contracts; medical and behavioral provider reimbursement models, contractual language. Knowledge of government healthcare regulations. Excellent verbal and written communication skills as well as excellent analytical and problem solving skills. Ability to work independently to resolve issues. Ability to manage multiple projects simultaneously. Ability to provide responsive customer service and follow through. Ability to develop, prioritize and organize projects to meet deadlines.

+ Operational Excellence – Ability to design, monitor and implement contracts that allow for optimized financial and operational performance.

+ Communication – Skilled listener and communicator to all audiences, individuals and groups.

+ Relationship Oriented – Ability to develop and leverage relationships with payers.

+ Collaborative Style – Collaborative nature with the ability to work across facilities and departments while at times juggling conflicting priorities. Ability to align practices and procedures with the organizational strategy of the health system by recognizing the implications of actions and anticipation of outcomes

+ Team Oriented – Builds teamwork by working to bring out the best in others and providing development feedback to staff and colleagues.

+ Service Orientation – Ability to foster a service culture.

Education:

+ Bachelors Degree required; Masters Degree preferred.

+ 5 to 7 years of experience directly related to the duties and responsibilities of the position.

Salary Range

USD $200,000.00 - USD $225,000.00 /Yr.

This range serves as a good faith estimate and actual pay will encompass a number of factors, including a candidate’s qualifications, skills, competencies and experience. The salary range or rate listed does not include any bonuses/incentive, or other forms of compensation that may be applicable to this job and it does not include the value of benefits.

At Catholic Health, we believe in a people-first approach. In addition to the estimated base pay provided, Catholic Health offers generous benefits packages, generous tuition assistance, a defined benefit pension plan, and a culture that supports professional and educational growth.