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Manager of Payor and Market Strategy
The University of Kansas Health System. Negotiate and renegotiate managed care contracts with managed care companies and health plans .
About the role
Key responsibilities & impact- Negotiate and renegotiate managed care contracts with managed care companies and health plans
- Develop negotiation strategies to achieve health system goals
- Report market opportunities and monitor changes to protect and enhance market share
- Develop and evaluate contract structures for reimbursement, including hospital, physician, ASC, bundled, value-based and capitated models
- Analyze contract requirements, provisions, terms, conditions, rates, proposals and counterproposals
- Meet with health plans and payers and prepare for negotiations and joint operating committee meetings
- Monitor contract performance and compliance, identify problem areas and help resolve disputes
- Coordinate with the contracting team across all entities
- Analyze utilization, revenue trends and financial data to identify contract-operation issues
- Engage payers regarding plan changes and policies
- Develop standard and ad hoc reports for budgeting, revenue projections and long-range planning
- Serve as liaison with Revenue Cycle and operational departments
- Maintain managed care contracts and update stakeholders on renewals, amendments and contract changes
- Build reimbursement models and reports using EPIC, payer portals, Excel and other reporting tools
- Support credentialing and re-credentialing for facilities and professional services
- Establish relationships with physicians, administrators, health plans, senior leaders and other stakeholders
- Participate in committees, team meetings, strategic initiatives and work groups
- Support Strategic Healthcare Solutions recruitment, business development, purchased-services onboarding and customer concerns
- Manage value-based initiatives by analyzing population, quality, efficiency and financial performance data
- Collaborate with quality teams to meet network quality and financial targets
- Serve as department liaison between payer contracting and clinical operations
Requirements
What you’ll need- Bachelor's Degree in Business Administration, Healthcare Administration or similar field from an accredited college or university OR other equivalent work experience
- 4 or more years of experience in a healthcare organization or within health industry in a financial or technical position or other equivalent work experience
- Ability to perform the professional, clinical and/or technical competencies of the assigned unit or department
- Preferred: Master's Degree in Business Administration, Healthcare Administration or similar field from an accredited college or university
- Preferred: Experience in a large healthcare organization or academic medical center in managed care contracting or financial modeling/analytics
Benefits
Comp & perks- Equal employment opportunity employer
- Reasonable accommodations for qualified individuals with disabilities
- Full-time employment