Manage the negotiation, preparation, financial analysis, business review, and implementation of assigned Managed Care clients, facility compounding agreements for home and alternate site infusion services provided by Option Care. Responsible for non-strategic managed care plans with less than 250K lives and typically less than $1,000,000 in annual revenues, but may include national network or workers compensation agreements, and non-financial amendments for all managed care clients as assigned by the Contracting Director for the territory.
Requirements
- Manage the negotiation of provider and Facility contracts in accordance with company guidelines for assigned geography for home and alternate site infusion therapy services provided by Option Care
- Manage internal implementations of assigned agreements with regional intake, operations, and revenue cycle teams in order to insure success of clean claims payment
- Manage external implementations and foster ongoing relationships with assigned accounts
- Subject Matter Expert for CPR+ Shared Contract and Insurance records and work with Contract System Management Analysts providing direction on new contract builds or changes
- Manage communication with assigned accounts as it relates to demographic changes to Option Care Facilities to insure health plan agreements are current in order to facilitate clean claim billing
- Initiate and lead meetings with health plans and corporate teams, including Managed Markets and Contracting leadership, to review provider agreement performance data and scorecards
- Recommends course of action to reduce/minimize risk to the organization
- Identifies, and assesses impact of potential changes in the industry or changes related to new state or federal legislation
- Resolve reimbursement issues identified by Payer Liaisons that may be related to contract compliance
- Recommends strategies to update and grow a sales representative’s understanding of the scope and intent of assigned managed care or facility contracts
- Maintains successful working relationships with internal departments such as Infusion Operations, Legal, Sales, and any other departments that are involved with or impacted by managed care contracts
- Utilize and participate in deployment of new contract management system
- Complete credentialing applications when necessary for new contract access as back up to contract coordinator
- Initiate monthly meetings with assigned Contracting Mentor(s) for development opportunities
- Participate in regional meetings as directed by VP, Contracting
Benefits
- Medical, Dental, & Vision Insurance
- Paid Time off
- Bonding Time Off
- 401K Retirement Savings Plan with Company Match
- HSA Company Match
- Flexible Spending Accounts
- Tuition Reimbursement
- myFlexPay
- Family Support
- Mental Health Services
- Company Paid Life Insurance
- Award/Recognition Programs
