- Overall responsibility for negotiating and providing oversight of Health Plan contracting for medical practice clients and Ambulatory Surgery Centers (ASC). Primary point of contact for Revenue Cycle management team for contractual questions. Liaison between Revo Health management team and Healthplans for outstanding contractual issues.
- Integral team member of Revo Health leadership and strategic teams.
- Responsible for initiating, negotiating and finalizing contract discussions upon renewal.
- Strong understanding of reimbursement methodologies for healthcare services.
- Proven ability to perform data analysis during contract negotiations.
- Establish and maintain database of payer newsletters, coverage and reimbursement policies.
- Communicate changes in payer coverage and reimbursement policies to clients and Revenue Cycle management team.
- Maintain database of payer networks and in/out-of-network status for each network.
- Conduct professional, frequent, timely, and appropriate communications with health plans, Revo Health leadership and Revenue Cycle teams.
- Actively participate in meetings and other communications processes; share information timely, accurately and completely with others as needed.
- Ensure compliance with all applicable laws, regulations, etc. (e.g., HIPAA, Stark, employment laws); company policies and procedures; business ethics; etc.
- Evaluate and develop data driven action plans for efficient, ethical, and productive business practices that lead to patient, employee and physician satisfaction.
- Develop short- and long-term training objectives and goals to ensure readiness for regulatory and industry changes.
- Develop and maintain written operational policies and procedures to ensure consistent processes for business office operations.
- Communicate with and manage internal and external business partner relations.
- Assist in identifying, recommending, and implementing operational changes that will improve service, productivity, quality and/or financial performance of the organization.
- Other duties as assigned.
- Bachelor's Degree preferred.
- 3 years of advanced experience in negotiating contracts with proven knowledge of healthcare reimbursement methodologies.
- Comply with company policies, procedures, practices and business ethics guidelines.
- Complete job required training.
- Comply with all applicable laws and regulations, (e.g. HIPAA, Stark, OSHA, employment laws, etc.)
- Demonstrate prompt and reliable attendance.
- Work in the clinic, office or surgery center during business hours.
- Travel independently throughout the clinic, office or surgery center (which may include movement from floor to floor); frequent bending, lifting, standing, stooping or sitting for long periods of time may be required.
- Work at an efficient and productive pace, handle interruptions appropriately and meet deadlines.
- Communicate and interact in a respectful and professional manner.
- Prioritize workload while being flexible to meet the expectations of the daily operations.
- Apply principles of logical thinking to define problems, establish facts, and draw valid conclusions.
- Understand and execute a variety of instructions.
- Effectively operate equipment and communicate on and operate the phone system.
- Work independently with minimal supervision.
- Travel to other work locations, if required
- Integrity - Do the right thing and take responsibility for what you do and say.
- Service - Consistently contribute to deliver an exceptional experience.
- Quality - Act with high purpose, committed effort, and skillful execution to exceed expectations.
- Innovation - Identify progressive solutions that improve service, teamwork, efficiency, and/or effectiveness.
- Teamwork - Be a part of the whole; support each other positively.
- Clinic/office/surgery center setting
- Twin Cities Orthopedics partners with a management services company, Revo Health, along with other healthcare groups to deliver exceptional patient care. This position will be employed through Revo Health, working closely with Twin Cities Orthopedics.
- Revo Health is an Equal Opportunity/Affirmative Action Employer and will make reasonable accommodations in compliance with the Americans with Disabilities Act of 1990 and the ADA Amendments Act of 2008.
- This position description will be reviewed periodically as duties and responsibilities change. Essential and Additional Job Functions are subject to modification.
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Manager - Health Plan & Contracting - - Bloomington, United States - Revo Health
Description
This is a full-time position working M-F from 8:30 am - 5:00 pm and is based out of the Revo Health Corporate Office in Bloomington.
Revo Health is a professional services company that partners with multiple healthcare groups to deliver exceptional patient care. This position will be employed by Revo Health, working closely with Infinite Health Collaborative (i-Health) and its operating divisions. We have a comprehensive Medical, Dental & Vision Plan, Maternity Bundle, 401K with Profit Sharing, Tuition Reimbursement, Gym & Car Rental Discounts and more.
Position Purpose Summary:
Essential Functions:
Education and Experience Requirements:
Essential Requirements:
Ability to:
Performance Expectations - Revo Health's Core Values:
Environmental Conditions:
Notes
