Managed Care Contracting, Performance Advisor

🕒 il y a 5 jours

🇺🇸 États-Unis – Télétravail

💵 $113 000 - $188 000 / an

⏰ Temps Plein

🟡 Intermédiaire

🟠 Senior

🦅 Parrain de Visa H1B

Cette entreprise a parrainé des visas H1B par le passé.

👻 Score fantôme 0%

Ce que ça veut dire : la probabilité que personne ne recrute vraiment pour cette offre.Comment le lire : 60 % ou plus, on pense que c'est une offre fantôme. Un score plus bas est moins inquiétant.Comment on la calcule : ancienneté, republications, postes ouverts vs taille de l'équipe, rapidité de clôture, et si le salaire est indiqué.À noter : une estimation à partir de données publiques, pas un jugement sur l'entreprise. De vraies offres peuvent avoir un score élevé, alors prenez-le comme un indice, pas comme un fait.

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Guidehouse

Site WebLinkedInTous les Emplois

10 000+ employés

Fondée en 2018

🏥 Santé

🎖️ Défense

📦 Logistique

💰 Grant en 2023-02

Healthcare • Defense • Logistics

Guidehouse est un cabinet de conseil international qui propose des services de conseil, digitaux et managés pour les secteurs privé et public. Conçu spécifiquement pour accompagner des industries telles que la sécurité nationale, les services financiers, la santé, l’énergie et les infrastructures, Guidehouse collabore avec des dirigeants pour naviguer dans la complexité et accélérer des transformations qui façonnent l’avenir. Son expertise couvre notamment le data analytics, les technologies digitales, le risk management, et bien plus encore, avec un fort accent sur le développement durable et l’innovation.

Description

• Strategically manage, evaluate, negotiate, implement, and monitor managed care contracts • Review and audit existing contracts to identify reimbursement improvement, optimization, and renegotiation opportunities • Perform financial modeling and reimbursement analyses for rate changes, amendments, and new payer arrangements • Evaluate contract language, reimbursement methodologies, payment policies, authorization requirements, carve-outs, and contractual obligations • Develop business cases and executive-level recommendations for contract strategy decisions • Develop and execute negotiation plans for commercial, Medicare Advantage, Managed Medicaid, and other payers • Analyze payer proposals and prepare data-supported counterproposals • Maintain payer communications and relationships to resolve negotiation issues and facilitate contract execution • Coordinate implementation of new or amended managed care agreements • Collaborate with Finance, Revenue Cycle, Patient Access, Case Management, Physician Services, Operations, and payer organizations • Develop contract summaries, reimbursement guides, and operational reference materials • Support payer configuration, billing implementation, reimbursement validation, and operational education • Resolve contract interpretation and post-implementation issues • Establish and monitor KPIs for reimbursement accuracy, denial trends, payment timeliness, underpayments, and revenue yield • Investigate, escalate, and help resolve underpayment, denial, and reimbursement disputes • Analyze payer performance and identify revenue recovery and compliance improvements • Prepare executive reports and presentations on contract performance, negotiation progress, financial impact, and recommendations • Identify and evaluate new payer, IPA, medical group, and physician contracting opportunities • Support physician network and medical group contracting strategies • Assist with value-based care, risk-based contracting, and alternative payment model initiatives • Contribute to managed care strategies supporting organizational growth, financial sustainability, and market expansion

🎯 Exigences

• Bachelor's degree and a minimum 6-8+ years of prior relevant experience, or an AA degree and 8-10+ years of prior relevant experience • Relevant experience may be substituted for formal education or advanced degree • Relevant experience in a healthcare provider, central business office environment, managed care, contracting, healthcare finance, payer relations, related healthcare administrative roles, or revenue cycle outsourcing company • Demonstrated experience negotiating managed care agreements with commercial and government-sponsored health plans • Experience performing reimbursement analyses, financial modeling, and contract reviews • Knowledge of hospital and physician reimbursement methodologies, including Medicare, Medicaid/Medi-Cal, DRG, APC, fee schedules, capitation, and value-based payment models • Strong understanding of managed care contract language and reimbursement structures • Advanced analytical and financial modeling skills • Ability to interpret complex contractual and reimbursement provisions • Negotiation, communication, and relationship-management skills • Ability to work effectively across multiple departments and levels of the organization • Strong project management and organizational skills • Proficiency in Microsoft Excel, PowerPoint, and healthcare financial analytics tools • Up to 10% travel • No clearance required

🏖️ Avantages

• Competitive compensation • Flexible benefits package • Medical, Rx, Dental & Vision Insurance • Personal and Family Sick Time & Company Paid Holidays • Position may be eligible for a discretionary variable incentive bonus • Parental Leave • 401(k) Retirement Plan • Basic Life & Supplemental Life • Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts • Short-Term & Long-Term Disability • Tuition Reimbursement, Personal Development & Learning Opportunities • Skills Development & Certifications • Employee Referral Program • Corporate Sponsored Events & Community Outreach • Emergency Back-Up Childcare Program

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