Position Goal
Manages existing and new payer contracts and fee schedules to ensure accurate reimbursement across our payers and Hughston entities. Manages Appeals Analysts to achieve organizational metrics on appeals, denials and recoveries.
Position Responsibilities:
Manage healthcare network participation, and negotiate and maintain competitive contracts with assigned healthcare insurance payers Works closely with all data owners to ensure claims and reimbursement data transfers are loaded to Contract Management system and Credentialing system in a timely and accurate manner Ensure contractual language is kept current; evaluate fee schedule on a yearly basis to identify possible opportunities for additional covered services, strategic partnerships, medical policy changes and reimbursement updates Facilitate training for new and existing staff members on Contract Management system tools Analyze Contract Management system reports to identify variances in claims payment data Ensures appeal staff work effectively and optimizes work flows Facilitate the review and approval process of all contract documents from pre-contract through post signature phases, accuracy of supporting documentation, and timely maintenance in systems Develop and maintain processes that provide timely notification and administration of critical contract events (e.g., annual rate updates, contract renewals, termination and other critical contract requirements) Assist with all contracting administration and projects, as needed Analyze claims data reports to identify trends, issues and recovery opportunities Conduct data modeling in support of payer negotiations Creates and implements policies and procedures to promote effective appeals and recoveries processesExperience:
Required:
Preferred:
Claims and reimbursement analysis and various reimbursement methodologies Appeals and denial recovery processes Leading and motivating a team System implementation experience is a plusEducation:
Required:
Special Qualifications:
Required:
The Hughston Clinic, The Hughston Foundation, The Hughston Surgical Center, Hughston Clinic Orthopaedics, Hughston Medical, Hughston Orthopaedics Trauma, Hughston Orthopaedics Southeast and Jack Hughston Memorial Hospital participate in E-Verify. This company is an equal opportunity employer that recruits and hires qualified candidates without regard to race, religion, color, sex, sexual orientation, gender identity, age, national origin, ancestry, citizenship, disability, or veteran status.