SR Managed Care Contract Specialist

Reports to the Manager of Managed Care. Responsible for assisting the Manager of Managed Care in negotiating, maintenance, problem resolution and internal coordination of assigned managed care contracts and proposals for Beacon Health System. Works with the Manager of Managed Care to Manage the contract process for Beacon Health System and is a lead for the department. Acts as a service representative for internal clients and payors, scheduling in-services as needed and works to operationalize the managed care agreements.

Responsible for maintaining contracting files and contracting system(s). Supports the management team by providing input into the strategic planning process. Responsible to assist with Beacon ACO and CHA ACO, LLC networks and CMS MSSP as directed.

This is a remote position. To be considered, candidates must reside in one of the following states:
California, Colorado, Florida, Idaho, Illinois, Indiana, Kentucky, Michigan, Minnesota, North Carolina, Nebraska, New Jersey, Ohio, Oregon, Pennsylvania, South Carolina, Tennessee, or Texas.

• MISSION:
  We deliver outstanding care, inspire health, and connect with heart.
• VALUES:
  Trust. Respect. Integrity. Compassion.
• SERVICE GOALS:
  Personally connect. Keep everyone informed. Be on their team.

• Notifying appropriate entities of all new contracts and any alterations of current contracts.
• Developing and circulating all quarterly reports.
• Working on the development of managed care contracts and proposed protocols with the assistance of management.
• Handling contract negotiation/renewal processes and/or undertaking these tasks as directed and/or necessary with the assistance of management.
• Completing administration and enrollment paperwork of new payors and manages maintenance and accuracy of contract management system(s) utilized by the department.
• Serving as a liaison with attorney regarding contract language.
• Attend all applicable meetings necessary to obtain approval on proposed agreements by Beacon Entities.

• Maintaining current contracts, credentialing information and roster of clients.
• Notifying appropriate entities of new payor groups.
• Coordinating activities and resolving problems of key internal functions such as Accounting, Billing, Collections and Registration.
• Assisting management with new product design.
• Assisting in the development and maintenance of policies and procedures to most effectively manage and monitor Managed Care activities.
• Evaluate and model proposed financial terms, making recommendations based upon the financial analysis performed to prepare for counter proposals to payers.
• Present new contracts and or revised fee proposals to Manager for approval

• Maintaining current knowledge base on benefit and network designs to act as service representative for internal and external contacts and maintaining payor database.
• Conduct and/or arrange regular education trainings for contracted managed care companies to ensure managed care provider tools and resources are known
• Coordinating and conducting training as needed for administrative staff.
• Maintaining information on the intranet site.
• Assess performance of contracted agreements for each Beacon Entity and communicate those findings to management to compose contracting strategies and goals yearly.

• Providing input into the departmental strategic planning process.
• Working with sales staff and assisting with Requests for Information (RFI’s) as needed.