* Oversees financial analysis and direction of proposed and current payer arrangements. Major areas of responsibility include contract analysis, negotiation, implementation, oversight, and payer relations. * Development and management of negotiations for payer contracts Manage financial, operational, and legal analysis of proposed payer agreements. * Develop payer strategies and priorities for the SOM/UP that support overall strategic and operational goals. * Execute third party payer contracting strategies on behalf of University Physicians. * Communicate the implementation of financial and operational requirements of third-party payer agreements. * Efficient communication and coordination of day-to-day managed care issues related to patient access, claims adjudication and collection, and medical care management. * Build and maintain positive working and contractual relationships with insurance companies, employers, physicians, and other third-party payers. * Monitor, instruct and advise staff on payer contract changes in policies, procedures or processes. * Directs monthly reporting by department and/or specialty on reimbursement on a monthly, year to date and year end basis, as well as trending reports * Maintain matrix of physician reimbursement specifics by payer, including modifiers, multiple surgery guidelines, silent PPO management and fee schedule analysis and maintenance. * Evaluate new contracting opportunities for the SOM/UP. * Maintain and develop Contract Management and Modeling system to identify incorrect payments, revenue changes, and payer trends. * Identify and recommend appropriate changes in operating procedures and systems that might be required to accommodate payer contracts. * Monitor managed care payers compliance with contractual requirements. Provide direction, support, and financial analyses regarding governmental payers regulations and reimbursement. Interpret new and revised regulations; perform analyses to determine financial impact. * Coordinate contract review with University of Missouri legal counsel. * Develop and maintain systematic approach to enroll providers with payers so that patients can access services in a timely manner and providers will be reimbursed for said services. * Perform a variety of tasks related to external audit processes such as Center for Medicare/Medicaid Service, Missouri HealthNet program, Office of the Inspector General, other governmental agencies, third party payers, etc. * Provide reports and analyses for ad hoc committees such as: Steering Committees, IT Implementation Teams, or Revenue Cycle Committee, etc. * Serve as a resource to executives, physicians and staff for the deployment of critical financial initiatives across the system. Provide leadership, maintains overall program direction, scope, budget, quality, work effort and issue resolution. * Prepare and present various financial analyses using historical trends, market intelligence, and reimbursement knowledge while being mindful of strategic goals. Work with various members across the organization related to financial and clinical outcomes and assists in ensuring effective utilization of data for informed decision making. Provides direction and interpretation of information, serving as a resource to leadership. * Facilitate evaluation and implementation of outreach opportunities in MU Health system's market area by developing proformas and fair market value analysis. Create a matrix of outreach service agreements for tracking and annual review. Develop analysis and proformas of options for outreach models for affiliation opportunities, representing the benefits and costs associated with such options * Cultivate strong professional relationships and coordinate with legal, compliance, clinical, operational, marketing and communications leadership to identify the appropriate pathways within MU Health System to build and meet the needs of targeted provider relationships. * Development and maintenance of tools that can be used to review fair market value to ensure the rates established in purchased service agreements are done so in a compliant manner. * Assist with development and implementation of alternative revenue sources such as Enhanced Medicaid and Missouri Medicaid Access to Physician Services Programs. Develops and facilitates relationships with MO HealthNet Medicaid Staff.
Salary Range: $87,630 - $136,178/year
University Title: DIRECTOR, CONTRACTING AND PROVIDER ENROLLMENT, UNIVERSITY PHYSICIANS
Internal applicants can determine their university title by accessing the Talent Profile tile in myHR.
Monday - Friday
Requires a Bachelor's degree in Health Administration, Business Administration or related discipline and a minimum seven (7) years progressively responsible health care managed care, reimbursement or provider relations experience, preferably in an academic medical center or large tertiary teaching hospital or in the provider relations area of a managed care company. Requires a strong knowledge of managed care contracts and reimbursement issues. Must possess strong database and spreadsheet development; analytical; presentation and communications skills, and work well in a team environment requiring a high degree of creativity and motivation.
* Requires a Bachelor's degree in Health Administration, Business Administration or related discipline and experience from which comparable knowledge and experience can be acquired is necessary. A Master's degree is preferred. * A minimum of seven (7) years (preferably nine (9) years) of progressively responsible health care managed care, reimbursement or provider relations experience, preferably in an academic medical center. * Requires demonstrated knowledge of managed care contracting, negotiation and financial analysis. * Must possess strong database and spreadsheet development; analytical; presentation and communications skills, and work well in a team environment requiring a high degree of creativity and motivation. * Experience with coordinating, reviewing and responding to governmental agency, i.e. OIG, requests, audits and other types of reviews is highly desirable. * Advanced knowledge of Medicare and Medicaid reimbursement methodologies and information systems.
This position is eligible for University benefits. The University offers a comprehensive benefits package, including medical, dental and vision plans, retirement, paid time off, and educational fee discounts. For additional information on University benefits, please visit the Faculty & Staff Benefits website at http://www.umsystem.edu/totalrewards/benefits
The University of Missouri is fully committed to achieving the goal of a diverse and inclusive academic community of faculty, staff and students. We seek individuals who are committed to this goal and our core campus values of respect, responsibility, discovery and excellence.
Equal Employment Opportunity
Equal Opportunity is and shall be provided for all employees and applicants for employment on the basis of their demonstrated ability and competence without unlawful discrimination on the basis of their race, color, national origin, ancestry, religion, sex, pregnancy, sexual orientation, gender identity, gender expression, age, disability, protected veteran status, or any other status protected by applicable state or federal law. This policy shall not be interpreted in such a manner as to violate the legal rights of religious organizations or the recruiting rights of military organizations associated with the Armed Forces or the Department of Homeland Security of the United States of America. For more information, call the Vice Chancellor of Human Resource Services/Affirmative Action officer at 573-882-4256.
To request ADA accommodations, please call the Disability Inclusion and ADA Compliance Manager at 573-884-7278.
EEO IS THE LAW
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