Managed Care Contracting Specialist
Headquartered in Phoenix, Integrated Medical Services is a team of 500 employees and a physician-led organization united through its providers’ commitment to high-quality innovative health care. Each day is a new day for ground-breaking ideas and unparalleled opportunity. Ours is a culture focused on what we can accomplish today, and where it can lead us tomorrow.
Integrated Medical Services, Inc. is currently searching for a professional, compassionate and knowledgeable individual to fill the position of Managed Care Contracting Specialist in our Revenue Cycle Department. The Managed Care Contracting Specialist is responsible for conducting analysis and the negotiation of profitable contracts between the IMS entities and third-party payers. This position will be the liaison with IMS team members, including IMS Partners, and the third-party payers in the identification and resolution of inaccurate third-party payments, reporting on actual reimbursement, payer performance (including payer report card maintenance) and prospective contract modeling.
**This position will be a hybrid role, working from home and in-office.
- In collaboration with leadership, identifies appropriate contracting and re- contracting opportunities and initiates discussions with key constituents. For new relationships or service lines, performs business and market analysis to determine viability of contracting. Collaborates with managed care organizations and internal/external stakeholders to gain a thorough understanding of payer-specific requirements, reimbursement logic, and limitations. Ensures contracting efforts remain aligned with enterprise goals.
- Coordinates and works directly with internal and external partners evaluating, analyzing, negotiating, monitoring, implementing contract terms, and providing data as it relates to both managed care, quality, and value-based contracts/programs.
- Manages all aspects of the contract life-cycle. Collaborates to assemble and gain an understanding of payer specific data, operational issues, and business review. Implements executed contracts cross-functionally, communicates contract changes internally, maintains appropriate documentation, reviews contract performance reports and makes appropriate recommendations.
- Monitors contract renewals and solicit input from key internal stakeholders to identify contract revisions. Conducts analyses and compiles information for review of strategic contract terms for management review and decision making to specified areas of concern. Participates in contract monitoring and support tools (matrices), by reviewing and interpreting contracts, extracting key information for use by internal and/or external customers, and keeping abreast of changes in company locations for inclusion in various matrices.
- Develops and executes communication plans to internal and external stakeholders related to payer relationships, negotiations, organizational contractual obligations, payor updates, payor communications, and developments in the managed care marketplace. Stays abreast of changing healthcare landscape to maintain awareness of competitor services and reimbursement models, as well as opportunities of improvement in the financial and operational components of managed care contracts. Leads discussions pertinent to contract performance, market changes, market intelligence, and strategic decision making.
- Analyzes and monitors financial aspects of contract performance of existing managed care contracts. Utilizes analysis for feedback on contract renewals, renegotiations or termination. Makes recommendations regarding participation or non-participation with new or existing agreements. Provides feedback to executive team regarding financial and/or operational issues with payers. Coordinates financial analysis of payer contract performance and modeling projections based on alternate contract agreements with payers, adverse trends, etc., and makes appropriate recommendations or conclusions.
- Manages contracts for joint ventures, acquisitions and new facility openings. Actively participates, leads and/or completes special projects, develops and implements tools for process improvements, and serves as a resource for contract interpretation.
- Ensures contract language is in compliance with Managed Care Standards & Guidelines.
- Minimum 5 years in health care or managed care industry, previous experience in the provider industry is highly preferable.
- Significant knowledge of contractual, administrative, health insurance and operational issues related to managed care organizations, physician groups, hospitals and health insurance benefit plan designs.
- Proven and extensive contracting technical skills; negotiation skills, contract preparation and implementation, report building and analysis, financial analysis and rate proposal development, and in-depth knowledge of various reimbursement methodologies.
- Highly developed communication and organizational skills.
- Experience assessing problems & implementing solutions.
- High School Diploma or GED
Joining Integrated Medical Services is more than saying "yes" to making the world a healthier place. It’s discovering a career that’s challenging, supportive and inspiring. Where a culture driven by excellence helps you not only meet your goals, but also create new ones. We focus on creating a diverse and inclusive culture, encouraging individual expression in the workplace and thrive on the innovative ideas this generates. Our hope is that each day you’ll uncover a new reason to love what you do. If this sounds like the workplace for you, apply now!
You can look forward to a generous compensation package including medical, dental, vision, short-term and long-term disability, life insurance, paid time off and a very lucrative 401K plan.
*IMS is a tobacco-free work environment
IMS is an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, national origin, sex, disability status, sexual orientation, gender identity, age, protected veteran status or any other characteristic protected by law. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.