Senior Managed Care Pricing & Contract Specialist - Market Relations

Senior Managed Care Pricing & Contract Specialist - Market Relations - Southwestern Health Resources

Senior Managed Care Pricing & Contract Specialist - Market Relations - Southwestern Health Resources

Southwestern Health Resources is looking for a highly skilled Senior Managed Care Pricing & Contract Specialist - Market Relations. Is that you?

Work Hours:

Full Time Days (8:00am-5:00pm) for 40 hrs/week (remote work allowed at manager's discretion)

Department Highlights:

• Hybrid Position
• Gain a sense of accomplishment by contributing to a teamwork environment.
• Receive excellent mentorship, comprehensive training, and dedicated leadership resources.
• Contribute and work on a cross functional team

What You Will Do:

Manage the analytics of assigned commercial payers. This includes developing and modeling commercial reimbursement proposals for hospitals, ambulatory surgery centers, imaging centers, infusion centers, urgent care, behavioral health centers and home health. 30%
Support continuous improvement of operational efficiencies of the agreements during the term of the contracts by monitoring and comparing estimated reimbursement to actual payments. Work with CBO on payment issues and attend JOC meetings. 15%
Assist parent companies with projects as it relates to reimbursement. 10%
Provide analysis and recommendations around service line pricing and margins using market research. Assist with Power Point presentations. 10%
Prepare monthly/quarterly/annual net revenue reports; identify and report on exceptions. 10%
Audit profiles in PMMC and provide needed calculation corrections to the PMMC team. Create contract profiles in PMMC and audit calculations to ensure that it is calculating appropriately. 25%

What You Need:

Education
Bachelor's Degree Business related field Req
Experience
4 Years Decision support or financial analysis to include SQL or relational database experience and/or reimbursement methodologies. Req

Skills
Strong math and computer aptitudes are needed in order to understand and model complex structures and relationships.
Effective communication and presentation skills.
Must be highly knowledgeable of hospital coding systems.

Supervision
Individual Contributor

ADA Requirements
Working Indoors 67% or more

Physical Demands
Sedentary

Additional Information

• Job Field:
  Support Services
• Shift: Day Job
• Schedule:
  
  Full-time