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Job Details

Managed Care Contract Manager

Company name
Renal Advantage Inc.

Location
Franklin, TN

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Profile

PURPOSE AND SCOPE:Supports Fresenius Medical Care North America’s (FMCNA) mission, vision, core values and customer service philosophy.  Adheres to the FMCNA Compliance Program, including following all regulatory and FMS policy requirements.  Secures out-of-network revenue critical to overall business through the negotiation, execution and administration of single patient letters-of-agreement (SPA’s) as well as Health Plan specific letters of agreement across assigned regions and/or business units.PRINCIPAL DUTIES AND RESPONSIBILITIES:Manages all activities required to secure critical, out-of-network commercial revenue through the process of negotiating individual patient letters of agreement with various health plans, third party administrators and self-funded employers across the country ensuring compliance with all applicable regulatory and company guidelines and requirements.  Contributes to development of related contracting strategies and decisions. Performs functions and duties with high level of autonomy and independence exercising sound judgment and decision-making when committing the company and performing within multiple agreement structures, with minimal guidance and/or supervision.Responsible for activities related to the negotiation and execution of single patient letters of agreement. Conducts competitive market assessment prior to initiating negotiation process.Leads negotiation efforts involving both Plan specific letters of agreement and single patient letters of agreement among commercial payors, self-funded employers, third party administrators and re-pricing agencies.Prepares comprehensive rate proposals and rate analyses, modeling the various impacts of the proposed terms to determine the most favorable outcomes/options.Reviews claims payment history to determine historical out-of-network payment trends by Payor.Facilitate collection via Billing Group contact of outdated accounts receivable prior to Letter of Agreement negotiation and/or execution.Initiates notification to appropriate billing offices and documents patient’s file all negotiated discounts.Facilitates the admission of the commercial patients into Fresenius dialysis clinics through prompt negotiations.  Administers the implementation of these agreements by communicating the financial terms pertinent to the terms of agreement to the business unit and supporting billing offices allowing for timely and accurate billing for appropriate dialysis services rendered.Maintains an automated log to manage the numerous requests for SPA negotiations, monitor the progress of active SPA requests, to provide information to the department regarding the current queue of requests, and to allow for senior management intervention/decisions regarding SPA priority and queue placement. Coordinates, audits and reviews the performance of executed agreements and related processes monitoring the performance to ensure the payor is adhering properly to the terms of the agreement.  Escalates all discrepancies and failures of the payor to adhere to contractual terms to appropriate senior management for resolution and corrective action.    Reporting functions include:Maintaining a log of all active and executed single-patient letters of agreement for utilization by other Managed Care department personnel as a resource regarding negotiated rates and to evaluate the consistency of payor rates. Submitting monthly reports by Business Unit measuring negotiation performance – to quantitatively track and measure the impact of each negotiated agreement on the revenue of the affected clinic, region or business unit.Maintains current knowledge of company strategic initiatives and goals and industry initiatives and requirements to ensure alignment between contracts initiatives, company goals and industry requirements and guidelines.Other duties as assigned.Additional responsibilities may include focus on one or more departments or locations.  See applicable addendum for department or location specific functions.PHYSICAL DEMANDS AND WORKING CONDITIONS:The physical demands and 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.EDUCATION:Bachelor’s Degree, Business or HealthCare Administration preferred, or equivalent education and experience required EXPERIENCE AND REQUIRED SKILLS:Minimum 3 to 5 years’ experience negotiating agreementsGood understanding of health insurance products and benefitsStrong organizational skills, with the ability to administer multiple tasks and prioritize.Excellent written and oral communication skills.Perform work at a high level of accuracy and timelines.Knowledge and training in business software applications such as Microsoft Office - specifically Excel and Word.Strong problem solving and time management skills with the ability to consistently work in a fast-paced environment.Sense of urgency regarding performance of assigned dutiesEO/AA Employer: Minorities/Females/Veterans/Disability/Sexual Orientation/Gender Identity,identifier:18000ER7,title:Managed Care Contract Manager,url:https://jobs.fmcna.com/job/franklin/managed-care-contract-manager/488/8369564,hiringOrganization:{@type:Organization,name:Fresenius Medical Care},jobLocation:{@type:Place,address:{@type:PostalAddress,addressLocality:Franklin,addressRegion:Tennessee,addressCountry:United States,streetAddress:,postalCode:37067}}}

Company info

Renal Advantage Inc.
Website : http://www.renaladvantage.com

Company Profile
Through our leading network of more than 2,100 dialysis facilities in North America and our vascular access centers, laboratory, pharmacy and affiliated hospitals and nephrology practices, Fresenius Medical Care provides renal services to hundreds of thousands of people throughout the United States, Mexico and Canada. We are also the continent's top producer of dialysis equipment, dialyzers and related disposable products and a major supplier of renal pharmaceuticals.

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