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Manager, ASC and Physician Group Contracting (Remote)

Company: Surgery Partners
Location: Mesa
Posted on: November 23, 2021

Job Description:

Manager, ASC and Physician Group Contracting - This position is fully remote and can be worked from any state! JOB SUMMARY: ESSENTIAL FUNCTIONS: * Develop strategies for payor negotiations based up on the value proposition of the ASCs and physician groups assigned to you. Physician contracting will include Anesthesia physicians and CRNAs. Works with facility leadership to implement payor strategies and determine alternatives when challenges arise. * Works to achieve facility specific budgets for payor contract reimbursement. Establishes goals for physician reimbursement based on market dynamics and leverage, and ensures our physicians are contracted with all payors where our facilities have contracts. * Assists with major payor negotiations lead by Sr. Director as necessary. Actively manages agreements between Surgery Partners ASCs and Physicians groups, including Commercial Payors, Managed Medicare plans, Managed Medicaid plans, worker's compensation, and exchange plans. * Assisting Revenue Cycle teams with difficult and unresolved issues that arise regarding underpayments, errors with credentialing or other payor contract issues. * Ability to interpret and analyze ASC contract modeling and Physician reimbursement methodologies as needed to support negotiations. Works collaboratively and effectively to identify any errors in analysis, trends in utilization of services, and issues with underpayments or overpayments by payors. * Develops solid positive relationships with payor representatives, including payor negotiators and provider relations representatives. * Establishes relationships with internal market leadership, CEO/CFO teams, ASC and Provider Group Administrators, and Business office managers. * Works with IPAs/ACO's and other physician organizations that may be the conduit for our physician contracting efforts. * Communicates effectively with internal leadership on the strategies, value proposition, and timing of payor renewals. * Educates ASC staff on payor issues, trends, market changes, new payor products, etc. * Works with analysts to review payments received after new contract implementation to ensure compliance and to compare to originally modeled results. * Ensures that any automatic renewal increases in provider contracts are implemented timely and accurately by payors. * Works with facility and group leadership to set appropriate charge levels for the market and modify when appropriate. Assists with notifications to payors of chargemaster updates. Implements amendments to agreements or communications as necessary to make rate adjustments required as a result of charge changes. * Provides detailed monthly reporting to ASCs and attends and provides updates to ASCs at quarterly meetings. Provides updates on payor negotiations to internal leadership through these reports and communications. Presents reports to internal customers. * Understands the market for ASC reimbursement in assigned geography, and seeks to achieve targeted market level reimbursement in all product negotiations. * Provides periodic and ad hoc payer reports and contract documents for executives, third party vendors, etc. * Ensures that contract document system is loaded accurately for all payor contract agreements. ADDITIONAL DUTIES & RESPONSIBILITIES: PHYSICAL DEMANDS: Requires sitting for long periods of time. Some bending, lifting, stooping and stretching required. Requires range of hearing and eyesight. Requires eye-hand coordination and manual dexterity to operate office equipment such as computer keyboard, photocopier, telephone and calculator. WORKING CONDITIONS: Normal office environment or work from home environment. MINIMUM QUALIFICATIONS: * Bachelor's degree required in business, technology or healthcare related field. * 2+ years of negotiation or provider relations experience between providers and major commercial payors in markets in the U.S. Experience with physician and ASC reimbursement methodologies. * Experience working with clinically integrated networks, ACO's, or other population health initiatives a plus. * Experience working with payors and billing office staff to resolve payment discrepancies. * Basic understanding of healthcare CPT coding and billing. * Excellent quantitative and analytical skills, with attention to detail to ensure that modeling for negotiations is accurate * Moderate knowledge of Excel and/or ability to expand knowledge quickly. * Solid understanding of payer contract reimbursement methodologies and application of payor policies on reimbursement expected under existing and future agreements. * Strong writing skills and ability to communicate effectively in order to negotiate key terms of payor agreements. * Understanding of healthcare industry trends in payor negotiations including contract language, product development trends, pay for performance programs, bundled payment programs, etc. * Understanding of provider reimbursement methodologies from Medicare, and knowledge of how Medicare reimbursement is updated from time to time. * Must be self-motivated and able to work independently. Inquisitive nature and interest in sharing knowledge among team members. * Must be able to provide timely written and verbal communication of complex negotiations to internal leadership. * Experience managing multiple projects and negotiations with varying teams and deadlines. * Strong communication skills necessary. * Team orientation toward success.

Keywords: Surgery Partners, Mesa , Manager, ASC and Physician Group Contracting (Remote), Executive , Mesa, Arizona

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