Contract Strategy and Reimbursement Consultant - Home Health

Job ID: J122261
Company: Highmark Health
Location: Pittsburgh, PA, United States
Full/Part Time: Full time
Job Type: Regular
Posted at: May 9, 2018

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Description

JOB SUMMARY

This job develops comprehensive provider contracting strategies that incorporate incentives for performance and align to the goals of the business. This job will lead the coordination efforts required to obtain appropriate medical records for the reimbursement process between multiple parties, including patients, providers, physicians/their staff, hospital billing departments, etc.

                                                                   

ESSENTIAL RESPONSIBILITIES

  • Performs management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.
  • Plans, organizes, staffs, directs and controls the day-to-day operations of the department; develops and implements policies and programs as necessary; may have budgetary responsibility and authority.
  • Strategy Execution: Implements and executes the function's strategy to narrow the provider network and focus on top-tier partners.  Promotes innovative, risk-based contracting with providers to incentivize delivery and outcome improvement, and meet corporate financial objectives.  Supports the maintenance of the provider network in defined territories and within the post-acute space.  Helps support provider contract negotiations with customer groups as needed.
  • Key Expectations: Participates in the analysis and development of negotiation strategy for financial terms with providers and in contract language review sessions with pertinent staff and legal counsel to assure alignment to the goals of the network.  Develops communications and communicate with appropriate personnel regarding new contract implications on reimbursement efforts.  Supports operational staff in contract term issue resolution with the providers.  Supports leadership in negotiating financial and contract terms and in negotiating specific patient agreements when necessary.
  • Leadership Support: Supports policy and procedure development as it relates to provider credential & re-credentialing, and assure alignment to network management strategies and goals.  Drives improvement initiatives established by leadership focused on billing, accounts payable and reimbursement processes.  Supports provider relations efforts as needed.
  • Other duties as assigned or requested.

REQUIRED EDUCATION

Bachelor's Degree- Business, Healthcare Administration or other related area required.

(Acceptable substitutions in lieu of a degree 1 ½ years’ experience  = 1 year college)

EXPERIENCE

Minimum:

10+ years' experience in healthcare and health plan payor management required

In-depth knowledge/experience of healthcare and PAC-related financial implication

KNOWLEDGE, SKILLS & ABILITIES

  • verbal communication skills; ability to communicate effectively both individually and in groups
  • General experience of other MS Office applications and contract/revenue management software
  • Broad experience in PAC price drivers and contracting methods
  • Proficient in external customer negotiations of contractual language; able to assess and interpret risk, contract language nuances, operational and process-oriented situations and the impacts of each

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity (http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf)
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.
For accommodation requests, please call HR Services at 844-242-HR4U or visit HR Services Online at HRServices@highmarkhealth.org

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