Insurance contract administrator
Saginaw
Overview:
To develop, maintain, implement and monitor contractual relationships with third party Insurance Payors on behalf of Covenant and its business units.
Responsibilities:
PRINCIPAL DUTIES AND RESPONSIBILITIES: 1. Under supervision of Director or Managed Care Contracting, works directly with Payors to negotiate contractual provisions and rates on behalf of Covenant Hospitals, Medical Group, Behavioral Health Services and other business units.2. Independently evaluate and analyze contract proposals including completing initial proposal responses and reviewing/revising contract language and operational requirements. Reviews contracts with in house legal-council and works through contract revisions with Payors.
3. Routinely monitor current contracts for appropriate rate structure, contract terms and annual renewals and/or re-negotiations and compliance with industry standards and guidelines. 4. Monitor marketplace for new contracting opportunities and make recommendations of changes to enhance Covenant contract portfolio.
5. Coordinate implementation of Payor arrangements and provide ongoing education and support throughout Covenant. 6. Collect and communicate relevant contractual requirements and issues to internal customers such as Utilization Management, Finance, Patient Billing, Administration, Legal, etc.
Information includes; payor relationships, operational requirements and contract terms. 7. Maintain comprehensive files of Covenant contractual relationships and update contract information in the contract database. 8. Maintain contract summaries on Covenant website 9.
Act as liaison between Covenant and Payors on contracting and operational issues, i.e. billing, utilization review, credentialing site visits, notification of site closures or new services. 10.Coordinate facility credentialing and re-credentialing.
11.Perform other duties as assigned.
Qualifications:
EDUCATION/EXPERIENCE REQUIRED:- Bachelors Degree in Business, Healthcare or related field.
- Minimum of four (4) years in the healthcare industry in a professional capacity.
- Knowledge of managed care organizations and integrated health systems.
- Previous contracting, provider relations and/or provider reimbursement experience.
- Comprehensive project management abilities.
- Excellent oral and written communication and presentation skills.
- Excellent organizational skills and ability to manage multiple projects simultaneously.
- Excellent interpersonal skills and ability to develop effective working relationship with both internal and external customers.
- Strong negotiation skills.
- Understanding of legal, business, and insurance operations principles.
Proficient in Microsoft Word.
PHYSICAL DEMANDS/WORKING CONDITIONS:- Normal office environment with minimal exposure to noise, dust, or extreme temperatures.
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