TPA Contracting Manager- Managed Care, FT, Days
North Mississippi Medical Center
Tupelo, MS
Full-time
Mental Health
Posted on December 10, 2021
Manages:
Reporting:
Regulatory:
General:
- Manages routine, day to day operations of the Managed Care Contracting Department
- Support NMHS system contract negotiations and underlying payer relationships across enterprise service lines that encompass varied facility, professional and ambulatory surgery center based specialties.
- Assist in detailed analysis of contract performance, and proposal modeling, and provide evaluation to leadership.
- Manage multiple concurrent contracting activities with while leveraging strong project management skills to drive progress on specific market strategies.
- Support onboarding of new acquisitions, entities and locations, and new provider affiliations to payer contracts.
- Facilitate maintenance of consolidated contract management system for accurate tracking of reimbursement terms and conditions
- Create and maintain effective relationships with Operations, other stakeholders, and payers related to contracting activities.
- Attend onsite visits with payers, clients, and centers that require market-specific strategies.
- Work in a matrix environment where multiple and competing customer demands are likely.
- Focus on client satisfaction through purposeful internal and external communication.
- Leads a team with a focus on optimum customer service
- Develops and implements effective communication strategies
- Interacts frequently with NMHS facility and department Leaders, educating staff, promote the managed care department, and resolving documenting problems to be addressed with payers
Reporting:
- Prepare reports and presentations to effectively monitor and report portfolio performance, the implications of negotiation proposals, and payer dispute resolutions
- Compiles data and reports appropriately
Regulatory:
- Adheres to NMHS/NMMC Policies/Procedures/Guidelines
- Complies with applicable State/Federal/Regulatory Policies/Procedures/Guidelines, regulations and laws
General:
- Must be thoroughly knowledgeable regarding Managed Care programs and policies
- Performs other related duties requested by Director while demonstrating a willingness, ability and team spirit to provide optimal customer service
- Bachelor's Degree in Business, Accounting or health related field; required
- Minimum of 3-5 years' Managed Care, Insurance, Pharmacy or Physician Office experience; required
- Excellent organizational and communication (verbal and written) skills; required
- Strong critical thinking skills; required
- Proficient with computers and database management; required
- Strong interpersonal skills; required
- Utilizes independent judgement while resolving identified NMHS issues pertaining to contract interpretation.