The primary responsibility of this position is to work effectively with America’s Division Joint Venture partner managed care staff, or on their own to negotiate payor contracts, monitor contract performance, and to build productive relationships with commercial, Medicare advantage, Medicaid Managed Care, Direct employers and other third-party payors which results in favorable revenue streams for America’s Division hospitals, ASCs, physician groups and other system providers. Director will monitor and plan for contract renewals, budget increases, and ensure that all renewals are completed. They will assist the hospital system CFO’s with budgeting for payor increases annually. Director should have market awareness of changes in payor products, payor policies, state regulatory and industry trends. Additional responsibility is to communicate and be a resource for information about contract terms, managed care department projects, payor processes, revenue cycle inquiries, and to facilitate the resolution of complex issues that arise from time to time. Director will work effectively with Ardent analysis resources to ensure that contract renewals are modeled for financial impact. Responsible for communications with third party payors regarding updates to the health system including changes in locations, additions, or other material system changes that will impact payor contracts and reimbursement. Director will facilitate regular communications and claims payment problem solving when the business office needs additional support. Director for the America’s Division will also support the contracting needs of the Patient Quality Alliance CIN network in Idaho and the ACO initiatives of the Topeka Physicians Group in Kansas.
Payor Contracting: Manages all components of the contract negotiation process for directly negotiated contract. Assist JV partners with payor negotiations on behalf of JV facilities and physician entities. This includes determination of financial and administrative objectives, analysis of financial reports, negotiating or assisting with negotiations of rates and language, following internal approval processes for contracts, and implementation of final contract for all commercial, Medicare, governmental, and other third-party payors. Works closely with Ardent VP of Managed care, hospital and medical group CEOs/CFO’s, and JV Partner staff to identify and implement contracting opportunities for revenue improvement and administrative efficiency.
Payor Relations: Accountable to develop productive and professional relationships with contracted and payors which reimburse America’s Division entities and physicians. Identifies opportunities with payors to acquire premier provider designations for hospital entities and physicians. Seeks opportunities for new patient volumes through payor initiatives.
Contract Administration: Director will communicate with hospital staff to ensure that all contracts and amendments are loaded into contract database. Director will distribute new contracts and information about new products to key staff members, and the teams that are loading contracts into computer systems.
Contract Performance: Participates in activities which result in improved contract performance, which include performing payor analysis and communicating with all Revenue Cycle teams. Participate and/or facilitate regular meetings with key payors to ensure continuing contract performance, identify payor issues affecting payment or operations, discuss/ resolve claim issues resulting from contract interpretation and/or language, and to assist hospital staff in developing relationships with payors. Meets regularly or as requested with Business Office and facility CFOs to discuss payor issues, changes in the health system business, changes in payor policies affecting reimbursement or administration, and any emerging payor concerns prior to incurring high dollar losses.
Analysis, Reporting, and Negotiation of Chargemaster Adjustments: Communicates chargemaster changes to payors and monitors responses and rate adjustments as required under the agreements. If needed, negotiates with each affected payor the correct financial adjustments and then notifies internal departments of final changes and effective date of such changes for contracts.
Contract Models and Financial Information: Works with Ardent team of contract modeling staff to communicate contract terms and modeling scenarios during negotiations. Interprets reports on proposals and counter proposals. A solid understanding of hospital and physician reimbursement methodologies is required to effectively work in this role.
Development and Maintenance of Departmental Informational Resources: Provides tools and information to enhance Managed care department’s resources for contract language, reimbursement negotiation, and overall knowledge of managed care. Evolve Managed care department processes, maintain, and revise as necessary to promote greater efficiency within the department.
Preparation of Reports: Upon completion of contract negotiation or managed care project, prepares reports as requested to communicate contract or project results.
Executive Summary: Upon completion of contract negotiations, prepares an Executive Contract Summary report, consisting of contract provisions and financial analysis. Seeks internal approvals as required by company policy. Ensures that dually signed agreements are received by the organization and filed in contract management systems as necessary.
Other Reports as Required: Prepares reports, such as payor comparisons or regarding specific payor contract information, at the request of Ardent’s corporate office or upon request by hospital leadership.
JV Partner Meetings: Meets monthly with JV Partner Managed Care staff or more frequently as needed to track contracting progress, update existing projects, and ensure that work is being completed in a favorable and timely manner. Tracks meetings with agenda and notes for follow ups by all parties.
Due Diligence Process: Coordinates preparation and completion of due diligence process for new entity acquisitions. Prepares documents for payors reporting changes in facilities or physician group information.
Continuing Education and Association Participation: Participates in Managed care, Healthcare Finance, and Management associations as opportunities to develop strategic relationships and experience continuing education events, such as conferences and meetings, which builds on current knowledge and infuses innovative ideas regarding managed care contracting. Participates in other continuing education opportunities for managed care, negotiation, finance, management, and leadership.
