Sr. Contract Manager

Purpose and Scope

Responsible for managing all aspects of the managed care contracted revenue function in the assigned Group(s). This involves the monitoring, analysis and evaluation of pertinent financial and marketing data, and detailed tracking and follow-up of all contracted revenue.

Principal Duties and Responsibilities

• Communicate executed managed care payer agreements to Operations Management and Revenue Cycle teams, ensuring timely and accurate dissemination.
• Ensure compliance with data collection, auditing activities, contract implementation analysis, and new contract performance monitoring.
• Audit billing systems to verify the accuracy of third-party payer contracts, track contract escalators, and notify payors while updating billing systems accordingly.
• Support budgetary reviews for financial changes to existing and future agreements, with potential responsibility for additional operationally defined markets.
• Lead negotiations with payors under the Managed Care Director's direction, including rate proposals and contract language discussions.
• Drive projects and initiatives that align with Managed Care goals, including internal audits of the contract management system and employee training.
• Perform financial analyses to support contract proposals, terminations, and payor consolidation, including claims data analysis, medication utilization, and rate structure conversion.
• Maintain and produce analytical reports to support managed care efforts, ensuring timely updates to contract management and Revenue Cycle Systems.
• Track and monitor facility changes with payors, assisting the credentialing department in obtaining documentation and maintaining payer demographic verifications.
• Analyze network data for growth, competitive analysis, and mentor staff as applicable.
• Manage the tactical execution of objectives, including cost management, methods, staffing, and providing leadership, coaching, and development plans for direct reports.
• Ensure compliance with company policies, procedures, and relevant laws, establishing internal systems to promote compliance across the team.
• Participate in and lead meetings, problem resolution, and coordination across internal departments and external customers.
• Act as an advisor to subordinates, managing employee performance, and providing technical guidance.
• Assist with various assigned projects and other duties as needed.

Supervision

May be responsible for the direct supervision of various levels of department staff.

Education

Bachelor's Degree required; Advanced Degree desirable.

Experience and Required Skills

• 6 – 8 years' related experience; or a Master's degree with 3 years' experience; or a PhD without experience; or equivalent directly related work experience.
• 3+ years' supervisory or project/program management experience preferred.
• Working knowledge of Generally Accepted Accounting Principles (GAAP).
• Strong computer skills with demonstrated proficiency in word processing, spreadsheet, database and email applications.
• Detail oriented with strong analytical and organizational skills.
• Strong oral and written communication skill to effectively communicate with all levels of management.