Financial Consultant - Managed Care Contracting

Transcription

1 HFMA-EMC PLACEMENT COMMITTEE NEWS Best of luck on your job search! Also, remember to check the Professional Recruiting section on our website. Financial Consultant - Managed Care Contracting Reporting to Director, support the managed care contracting function by performing the necessary financial analysis to evaluate rate proposals, existing reimbursement terms, and health plan payments on behalf of HFHS Hospitals, physicians, Behavioral Health Services and other business units. Independently perform financial analysis to develop and evaluate reimbursement rate proposals and evaluate plans financial performance. Work with EPIC Contract Modeling team to create simulations using the EPIC XR Contract Modeling tool of rate proposals. Assist Managed Care Contracting team in working directly with payors to negotiate financial and reimbursement terms of contracts. Monitor contract payor rates and identify opportunities for rate renegotiation. Create and/or review rate sections of proposed contracts and amendments to ascertain that all necessary reimbursement terms are addressed, and the rates are depicted as negotiated. Develop and maintain a thorough understanding of HFHS payor contract reimbursement terms. Review Hospital Rate Grids maintained by the department to ensure they are complete, accurate and current. Provide guidance and assist Sr. Financial Analysts and Financial Analysts. Provide System leadership and education in area(s) of expertise. Maintain expertise in reimbursement methodologies and regulatory changes as they apply to payor contracts. Perform other duties as assigned. Bachelor s Degree in Finance, Accounting, Business Administration or related field required. Master s Degree preferred. Five (5) years of experience in healthcare finance or reimbursement in a progressively more responsible professional capacity including experience with various reimbursement methodologies (DRGs, per diems, fee schedules, case rates, etc.), including at least one (1) year of payor reimbursement analysis and/or negotiation. Excellent oral and written communication, and presentation skills. Excellent analytical, organizational and interpersonal skills. Understanding of reimbursement and managed care concepts. Proficient in Microsoft Excel and Microsoft Access (queries and reports).

2 APPLY ONLINE: Manager - Managed Care Contracting Reporting to Director or Manager, provide direction to and review work of Contract Administrators and work directly with Payors to lead negotiation of contract provisions and rates on behalf of HFHS Hospitals, Medical Group, Behavioral Health Services and other business units. Manage and lead the contracting team that will evaluate and analyze contract proposals including completing initial proposal responses and reviewing/revising contract language and operational requirements. Review contracts with in house legal-council and work through contract revisions with Payors. Hold contracting team accountable for completing work accurately and timely. Keep Director informed on issues and progress. Assist in developing Value Based contracting guidelines and take lead role in negotiating Value Based contract models and other complex payor relationships. Routinely monitor current contracts for appropriate rate structure, contract terms and annual renewals and/or re-negotiations and compliance with industry standards and guidelines and ensure contracting team renews/renegotiates contract as needed. Monitor marketplace for new contracting opportunities and make recommendations of changes to enhance HFHS contract portfolio. Lead team in coordination and implementation of Payor arrangements and provide ongoing education and support throughout HFHS. Lead team in collection and communication relevant contractual requirements and issues to internal customers such as Utilization Management, Finance, Patient Billing, Administration, Legal, etc. Ensure team maintains comprehensive files of HFHS contractual relationships and maintain contract information in the contract database. Act as liaison between HFHS and Payors and facilitate resolution of contracting and operational issues, i.e. billing, utilization review, credentialing site visits, notification of site closures or new services. Assist in the development and revision of department policies and processes. Provide System leadership and education in area(s) of expertise. Perform other duties and projects as assigned. Bachelor s Degree in Business, Healthcare or related field required. Master s Degree preferred. Five (5) years in the healthcare industry in a progressively more responsible professional capacity, with at least two (2) years payor contracting or provider relations. Experience with value based contracting preferred.

3 Experience negotiating financial terms of contract agreements preferred. Knowledge of managed care organizations and integrated health systems. Comprehensive project management abilities. Excellent oral, 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 and Excel. APPLY ONLINE: Senior Treasury Analyst This position will assist s Treasury Department leadership with the administration of growing and increasingly complex investment portfolios. The primary focus of this position is to perform day-to-day administrative support of a growing, multi-asset, multiple-manager investment program, with growing emphasis on alternatives including private markets and hedge funds. Administer private equity capital calls and capital distributions, including fund transfers and reconciliations to fund commitments and capital account statements. Perform fund valuations, including interim reconciliations, of investments including alternative assets including private markets and hedge funds. Analyze and interpret financial statements of investments. Monitor alternative investment performance comparing against benchmarks and reviewing portfolio holdings. Participate in alternative investment portfolio reviews and meetings with fund managers. Interpret and respond timely to investment fund amendments, side letters and due diligence requests. Work with legal team, tax experts and accounting leadership to support optimal tax and accounting treatment. Review and document all alternative asset funds communications, including organizational changes, ADV updates, K-1s, capital statements, quarterly financials, etc. Support management in implementing new alternative investment fund subscriptions as program continues to grow. Support annual external audit process. Support management with other reporting and projects as requested.

4 Bachelor s Degree in Finance or Accounting required; Master s Degree preferred. 5 years of related work experience required. Experience in investment accounting, including alt assets, hedge funds, private equity, or other private markets experience preferred. Direct experience administering alternative asset investments helpful. Strong analytical skills, attention to detail, and proficiency with computer applications including Excel, Word, and Power Point required. Ability to communicate effectively both written and orally, relay ideas to management, and work in small treasury team environment necessary for job. A desire to cross train to provide back-up other treasury functions as needed. APPLY ONLINE: Director Provider Contracting - HAP The Director of Provider Contracting will direct the negotiation of cost effective contracts for Hospitals, PO, and PHO. Provide leadership to direct staff regarding engagement, performance management, growth and development. Directs the negotiation of cost effective contracts for Hospitals, PO s and PHO s. Evaluates and negotiates contracts in compliance with company contract templates and reimbursement standards while maintaining network composition that includes an appropriate distribution of provider specialties. Prepares, analyzes, reviews and projects financial impact of complex provider contracts. Directs departmental staff to include interviewing, hiring, training, developing, mentoring, disciplining, evaluating, counseling and terminating in conformance with HAP policies. Perform other related duties as assigned. Bachelor s Degree in related field. Experience working in an insurance or hospital/healthcare setting strongly preferred. Minimum of five (5) years contracting and negotiating experience involving complex delivery systems and organizations. Minimum of five (5) years supervisory experience. Understands the reimbursement capabilities of FACETS and creates cost-saving provider reimbursement strategies and practices consistent with these capabilities

5 Must be able to speak and write clearly and concisely while conveying complex or technical information in a manner that others can understand. Superior problem solving, analytical, decision-making and negotiating skills. Team player with proven ability to develop strong working relationships. Must possess a strong orientation toward superior provider and employee satisfaction and effective interpersonal and conflict resolution skills. Must have proficient experience with Microsoft Office programs. Basic knowledge of Medicare reimbursement methodologies. APPLY ONLINE: