Manager Managed Care Contracting and Payor Relations Managed Care Pennington NJ

Capital Health is the region’s leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advanced technology. Capital Health is a dynamic health care resource accredited by the DNV that includes two hospitals, an outpatient center, satellite ED, and an expansive network of primary and specialty care. Capital Health Medical Group is made up of more than
600 physicians and other providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region.

Capital Health recognizes that attracting the best talent is key to our strategy and success as an organization. As a result, we aim for flexibility in structuring competitive compensation offers to ensure we can attract the best candidates.

The listed pay range or pay rate reflects compensation for a full‑time equivalent (1.0 FTE) position. Actual compensation may differ depending on assigned hours and position status (e.g., part‑time).

$88,712.00 - $

40

Support Payor operations to enhance relationships and improve operational, efficiency with Commercial, Medicare, Medicaid and other insurance programs. Responsible for enhancing reimbursement, network access and reducing revenue cycle challenges.

• Education:
  
  Bachelor’s degree in Accounting, Business or related field. A high school diploma or equivalent and additional years of experience may be considered in lieu of a formal Bachelor’s degree.
• Experience:
  
  Four years of progressively responsible experience in payor contracting and payor relation activities when accompanied by a Bachelor’s degree. Eight years of progressively responsible experience in payor contracting and payor relation activities when accompanied by a high school diploma or equivalent. Prior management experience is preferred.
• Other Credentials:
  Knowledge of contract management systems; strong analytical and interpretive skills. Possesses excellent organizational, interpersonal, verbal, and written communication skills, leadership and problem‑solving skills. Ability to effectively manage multiple projects simultaneously and respond quickly in a fast‑paced environment.
• Special Training:
  Familiarity with medical terminology, CPT and ICD‑10.
• Usual Work Day: 8 hours
• Reporting Relationships:
  This position formally supervises employees and has delegated authority to hire, terminate, discipline, promote or recommend to manager.

• Maintain and enhance relationships with payors to improve efficiency of revenue cycle, contracting and working relations.
• Assist VP of Payor Relations in preparing positive relationships and effective communication channels with payors to improve operational relationships and resolve issues.
• Attend payor meetings to review operational issues, maintain, and communicate payor outstanding issues and needs.
• Participate and support payor contracting negotiation strategies and implementation.
• Collaborate with senior leadership to align payer strategies with overall organizational goals.
• Support leadership in monitoring and reporting financial performance of assigned payor contracts versus expectations to assure achievement of negotiated rates.
• Develop and monitor KPIs to assess payor performance; identify challenges and opportunities to improve hospital reimbursement and operational efficiency.
• Use data and KPIs to recommend strategies to optimize payor mix and reimbursement rates.
• Monitor and manage payor contracts to assure adherence to contracted terms and provide recommendations during contract negotiations.
• Monitor and measure payor issues that impact revenue cycle, quality and utilization review.
• Escalate, address, and resolve issues and disputes with payors in a timely and effective manner.
• Monitor changes in market trends, healthcare laws, regulations and clinical policies that impact payor contracts and relationships; provide recommendations to address such issues.
• Communicate and facilitate sessions on key contract and policy changes and share findings with leadership.
• Manage and oversee contract amendments, policy…