Somnia Inc.

Managed Care Contract Administrator

Job Locations US-NY-Harrison
ID
2020-1535
Category
Corporate
Type
Full-Time

Overview

As the Managed Care Contract Administrator, you will work under the oversight of the VP of Patient Revenue and join a team of professionals representing Somnia Anesthesia and its affiliated companies nationwide. As a member of this team, you will play a key role in strategy, development, implementation, and ongoing management and monitoring of the managed care contracts nationwide, providing input into the development of managed care processes, identifying non-rate issues and reviewing/revising contract language. You will participate in the development of an overall strategy for managed care contract activities and rate negotiations

Responsibilities

Develop new managed care contracts and modifications of existing managed care contracts nationwide in a manner consistent with the Somnia’s strategic approach to managed care payer contracting.

  • Evaluate anesthesia rate proposals and changes to reimbursement methodologies and conduct related analyses to ensure continued financial viability of the contract.
  • Participate in the development and administration of alternative payment models (APMs), including bundled payments, risk sharing and global payment arrangements.
  • Participate in the development of management reporting systems to measure, track and monitor utilization and financial performance of managed care contracts. Communicate results with key stakeholders.
  • Assist internal clients with the resolution of complex payer issues. Coordinate meetings with contracted payers to address operational and/or payment issues and recommend changes to internal processes as needed.
  • Establish and maintain positive working relationships with both internal and external customers to improve quality outcomes while optimizing reimbursement or by lowering costs.
  • Adhere to compliance policies, and any applicable laws and regulations.
  • Bachelor's Degree
  • 5 years related job experience is required

Qualifications

Working knowledge of national hospital, physician and ancillary provider reimbursement methodologies. Anesthesia specific experience a plus.

  • Experience in managed care contracting rate negotiations, ACO and quality performance and working in a healthcare environment.
  • Strong interpersonal and communication skills, proven research and analytical skills, and ability to handle multiple priorities.

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