Full Time 40 hours Grade 055 URMC Payer Contracting & Reimb Schedule 8 AM-5 PM Responsibilities General Summary: With direction from the Director, Contract Management URMFG, but with latitude for independent judgment, the Contract Manager provides support for the financial success of the University of Rochester Medical Faculty Group (URMFG), Highland Hospital employed physicians, Strong Memorial Hospital, Highland Hospital, and other ancillary services as needed. Contract manager negotiates, executes, implements, and evaluates non-risk and out-of-area payer contracts for these entities. Key Functions: Maintains responsibility for development, negotiation, implementation and performance monitoring of preferred provider organization and out-of-area managed care payer agreements. Facilitates activities related to contract implementation among multiple departments. Works with the Director of Contract Management to perform, coordinate, and monitor activity related te financial and non-financial terms and interactions with payers. Acts as a liaison between hospitals, providers, departments, Utilization Management, Office of Counsel, Compliance, URMFG Business Office, etc. and payers. Recommends strategies for performance improvement. Provides analytical assessment of financial contract terms and performance. Has a clear understanding of physician and midlevel reimbursement methodologies. Advises Director of Contract Management on contractual, administrative and fiscal activities of payers. Directs the development of analyses needed for financial and non-financial decision making. Evaluates contract effectiveness in terms of opportunities, risks, financial and operational feasibility. Understands, maintains, and facilitates URMFG department and payer issues as they relate to contracting. Contract Manager works directly with URMFG Payer Relations Manager and coordinators, decision support, department program administrators and revenue cycle managers, office of counsel etc. to resolve issues; will also work directly with chairs and faculty as needed. Contract Manager maintains up-to-date and thorough knowledge of third-party payer reimbursement, contract obligations, and NYS and Federal statutory regulations regarding contracting and insurance (e.g. Healthcare Marketplace/Exchange Plans, EssentialPlans, Medicare/Medicaid, etc.) Meets regularly with insurers to assure contractual conditions and reimbursement terms are adhered to and issues are resolved. Educates and provides interpretive assistance and guidance to hospital and physician group staff regarding contract terms, requirements, implementation plans and care delivery systems. Presents contracting perspective to internal committees and workgroups. At the direction of the Director of Contract Management, position functions as project manager as needed. Represents Director of Contract Management in his/her absence as needed. Maintains Payer Contract Matrix, files, documentation, and posts various documents to the URMFG United Share Point site. Performs additional duties as required. Qualifications Bachelor's degree required, masterâ??s degree preferred, in business/administration, finance, management, healthcare, or other relevant course of study. Minimum 5 years' experience in functions as described above with contracts of significant dollar value. Excellent communication skills, both verbal and written. Contract and negotiation experience with excellent organizational, problem-solving and customer service skills; knowledge of physician reimbursement methodologies. Excellent analytical ability; proficient in Excel, able to quantify financial impacts in spreadsheet format. Ability to work in a team setting with all levels of management and staff.
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