Contracts Manager

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🕒 Maio 21

🐊 Florida – Remoto

🐊 Florida – Remote

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Integrated Home Care Services, Inc.

SiteLinkedInTodas as Vagas

501 - 1000 funcionários

Fundada em 2015

⚕️ Seguro de Saúde

🤝 B2B

Healthcare Insurance • B2B

A Integrated Home Care Services, Inc. é uma gestora integrada de benefícios de cuidados domiciliares que coordena e gerencia serviços de saúde domiciliar baseados em valor, equipamentos médicos duráveis e infusões domiciliares para pacientes e membros em nome de planos de saúde e prestadores de serviço. Ela oferece desenvolvimento de rede e credenciamento, gestão de utilização, adjudicação de sinistros, análises e uma plataforma habilitada por tecnologia para referências, documentação em tempo real e acesso 24/7 aos serviços, visando reduzir custos, melhorar resultados e simplificar a administração para pagadores, provedores e pacientes.

Descrição

• The Manager of Contracts is responsible for overseeing payer contract management activities within the Revenue Cycle Management (RCM) department for a home health and durable medical equipment (DME) organization. • This role serves as the subject matter expert for payer reimbursement terms, contract interpretation, fee schedules, and operational requirements that impact billing and collections. • The Manager of Contracts works closely with payers, revenue cycle leadership, compliance, credentialing, billing operations, and IT/system teams to ensure payer contract terms and reimbursement requirements are accurately translated into operational workflows and system configurations. • This position also supervises a Contracts Specialist responsible for loading payer pricing, fee schedules, and contractual requirements into company systems and electronic networks (ENS). • Review, analyze, and maintain payer contracts for home health and DME services. • Interpret reimbursement methodologies, fee schedules, billing rules, authorization requirements, and payer-specific compliance obligations. • Identify operational impacts of payer contract terms and communicate requirements to appropriate departments. • Monitor contract performance and reimbursement trends to identify discrepancies, underpayments, or revenue leakage opportunities. • Collaborate with leadership on contract renewals, amendments, and payer negotiations by providing operational and financial insights. • Maintain a centralized repository of payer contracts and related documentation. • Establish and document payer requirements for implementation within company systems, ENS platforms, and billing workflows. • Ensure payer-specific pricing, billing edits, authorization rules, and reimbursement requirements are accurately configured and maintained. • Partner with IT, billing, and operational teams to validate system setup and resolve configuration issues impacting claims or reimbursement. • Oversee testing and validation processes for payer updates, fee schedule changes, and system enhancements. • Supervise and support the Contracts Specialist responsible for loading pricing and contractual requirements into company systems. • Review and approve fee schedule uploads and payer configuration updates for accuracy and completeness. • Provide training, guidance, and performance management for direct reports. • Develop and maintain standard operating procedures related to payer contract implementation and maintenance. • Ensure payer contract requirements are implemented in compliance with federal, state, and payer regulations. • Serve as a resource to billing, collections, intake, and operational teams regarding contract interpretation and payer requirements. • Assist with audits, appeals, and reimbursement investigations related to payer contract terms. • Support continuous improvement initiatives focused on reimbursement accuracy and All other related duties as assigned.

🎯 Requisitos

• Bachelor’s degree in Healthcare Administration, Business, Finance, or related field preferred. • Minimum of 5 years of experience in healthcare revenue cycle, managed care contracting, payer relations, or DME/home health reimbursement. • Strong understanding of home health and DME payer reimbursement methodologies, billing requirements, and revenue cycle operations. • Experience interpreting managed care contracts and translating contract terms into operational requirements. • Prior experience managing or supervising staff preferred. • Knowledge of Medicare, Medicaid, commercial insurance, and managed care payer structures. • Experience with healthcare billing systems, fee schedule management, and payer configuration processes. • Strong analytical, organizational, and problem-solving skills. • Excellent communication and cross-functional collaboration abilities. • Comprehensive knowledge of managed care industry and product administration/implementation.

🏖️ Benefícios

• Medical, Vision, Dental, Short- and Long-term insurance • 6+ Days of Holidays Pay • 17 days of PTO • Employer paid life insurance • 401K with employer contribution • Wellness program with reward incentives • Employee recognition and reward programs • Comprehensive paid training program