Network Contracting Rep

Network Contracting Representative

Full-Time

Schaumburg, IL

Salary Range $65,000-$107,000

Benefits Include:Medical, Dental and Vision Coverage; 401(k); Healthcare Savings Account; Generous PTO Package; Health and Wellness Perks Program

SCOPE: Recommends, develops, administers, implements and coordinates multiple activities in support of the managed care organization and its strategies. Works closely with the Executive Director, practice management, physicians, and the Regional Director of Managed Care in market assessments, payor relations, referral relations and reporting, managed care contracts administration to include proformas, pricing analysis and data gathering. Supports and adheres to the US Oncology Compliance Program, to include the Code of Ethics and Business Standards.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

-Assists Business Office Managers, Executive Directors and Regional Director of Managed Care in evaluating managed care reimbursement proformas, contract language, and other proposal components. Coordinates the routing distribution of documents to complete the contracting process in a timely manner.

-Maintains active and pending managed care contract files. Solicits, integrates, and distributes data required for the maintenance of a managed care contracts system. Assists Regional Director of Managed Care with all documentation required in order to coordinate a consistent corporate response to field requested bids and quotes.

-Represents the Medical Group and Management to referring physicians, payors, hospitals, employees, and the healthcare community as directed by the Executive Director and Regional Director of Managed Care. Ensures that the Business Office and other Management members of the medical group are properly notified of contract additions and changes.

-Reports quarterly on reimbursement trends occurring with local market payors. Periodically solicits changes in reimbursement guidelines (public and private sector) from the appropriate reimbursement personnel with each Medical Group. Assists in the coordination and communication to provider relations representatives or appropriate party regarding amendments, reimbursement changes, and language changes.

-Coordinates meetings between Business Office and Provider Relations Representatives on a local basis. Requests information of J codes, CPT, membership, plan structure, and other information needed to complete the contract profile.

-Maintains awareness of competitive managed care activities and marketing developments providing input into the market analysis on an annual basis and adjusting the strategic business plan as needed. In conjunction with the Regional Director of Managed Care, coordinates the evaluation of local proposals, bids, and or quotes. Monitors, tracks, and reports on requests for proposals, bid and/or quote requests, managed care inquiries, number of existing and new contracts evaluated on a quarterly basis and related solicitations.

-Maintains thorough knowledge of managed care and related customer needs. Recommends changes in action plans, strategic objectives, and payor relationships according to market knowledge and analysis of reimbursement.

-Responsible for development and ongoing compliance of managed care goals and objectives within areas of responsibility and provides updates to appropriate parties by tracking progress on a monthly basis. At the direction of the Executive Director and Regional Director of Managed Care, works with the local/regional Controller, business office and clinical staff to support managed care activities. Participates in managed care contracts committees.

-Administers short-term and long-range market plans in conjunction with Executive Director and Regional Director Managed Care based upon corporate goals and objectives. Advises and assists the Regional Director of Managed Care in developing Regional/Market objectives, as they relate to areas of responsibility and plans for their achievement.

-Undertakes special studies on projects as requested by the Regional Director Managed Care and other executives generally involving growth planning of the Company. Works directly with Regional Director of Managed Care in developing reports to be presented to Executive and Joint Policy Board to track contractual allowances, patient visits, new visits, hospital days, and revenue by payor. Ensures products/services are developed in accordance with budgeted objectives and market pricing.

-Provides training and inservice sessions to billing, collecting, and business office staff for new agreements and any material changes that may impact business operations. Ensures availability of competent personnel for departmental and operational activities. Ensures they are properly trained and fully informed.

-Performs market analysis to identify market opportunities and threats in the market. Develops action plans to implement objectives associated with opportunities and threats. Works with Regional Director of Managed Care to assess the strengths and weaknesses of the medical groups internal operations and market positions.

MINIMUM QUALIFICATIONS: Bachelors degree in Business, Marketing, Healthcare Administration or related business field. Minimum five years experience in managed care and contract negotiations.

PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Requires sitting for long periods of time. Some bending and stretching required. Adequate finger dexterity and feeling to perform keyboarding and substantial repetitive motions involving the wrists, hands and/or fingers. Requires corrected vision and hearing to normal range. Must be able to view computer screen and printed material accurately. Occasionally lifts and carries items weighing up to 40 lbs.

WORK ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The work environment is typical of an office setting. Requires occasional travel by air or automobile.