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Contract Administrator - Managed Care

$85,482 – $150,000 yearly

Cincinnati Children's Hospital Medical Center

Last Updated: 2/13/24

Job Description

Expected Starting Salary Range: $85,481.76 - $115,000

At Cincinnati Children’s, we come to work with one goal: to make children’s health better. We believe in a holistic team approach, both in caring for patients and their families, and in advancing science and discovery. We strive to do better and find energy and inspiration in our shared purpose. If you want to be the best you can be, you can do it at Cincinnati Children’s.

Cincinnati Children's Hospital Has Been Named:

The #1 Pediatric Hospital in the Nation- US News and World Report 2023

One of four Medical Centers making the list of the 2022 Glassdoor Best Places to Work

An LGBTQ+ Healthcare Equality Top Performer in 2022 by The Human Rights Campaign (HRC)

Market Leading Benefits Including:

Medical coverage starting day 1 of employment. View employee benefits here: https://www.cincinnatichildrens.org/careers/benefits

Pension plan and optional 403(b) supplemental retirement plans

Tuition reimbursement for continuing education

Expansive employee discount programs through our many community partners

Referral bonus program for current staff!

Support through Employee Resource Groups such as African American Professionals Advisory Council, Asian Cultural and Professional Group, EQUAL - LGBTQIA Resource Group, Juntos - Hispanic/Latin Resource Group, Veterans and Military Family Advocacy Network, and Young Professionals (YP) Resource Group

Physical and mental health wellness programs

REPRESENTATIVE RESPONSIBILITIES

  • Payor Relations - Coordinate, analyze, and negotiate all financial and operational aspects of contract proposals and arrangements. Assist in coordinating/monitoring third party payor implementation activities, including acting as a resource for internal operations. Prepare correspondence to third party payors and MCPs for purposes of disputing or appealing policies, underpayments, or denials which effectively explain the agreement provisions or regulatory requirements under which they are non-compliant.
  • Contract Negotiation - Negotiate all aspects of PHO, hospital, physician, specialty, population health, and COE transplant network contracts, as well as ancillary contracts for home health, home infusion, durable medical equipment, hospice, reference laboratory, behavioral health, vision, dental, pharmacy, and specialty pharmacy. Partner with departmental and facility subject matter experts in focus areas to ensure specialty contracts address specific needs for that discipline. Negotiate single case agreements with non-contracted Medicaid, Medicaid HMO, and commercial plans as well as international cases. Establish and maintain relationships with specific contract negotiators with third party payors.
  • Contract Management - In collaboration with Revenue Cycle Compliance maintain and evaluate the effectiveness of the contract management process for all third-party payor contracts and related documents. Ensure all new or renegotiated contracts or amendments and any supporting documents are loaded into contract management information system in a timely basis. Assess the quality of the contract information entered into the contract management system. Maintain contract summaries outlining contract terms for third party payors.
  • Financial Modeling and Reporting - Obtain a complete understanding of Cincinnati Children's managed care contracting strategies and participate in the development of applicable contract strategies as directed by management. Prepare a negotiation strategy for individual payors, assessing the strengths and weaknesses that both Cincinnati Children's and the payor have in the negotiations. Review proposed contracts to identify issues of importance as applied to hospital operations, revenue, delegated credentialing, legal concerns, and utilization review. Prepare contract comments to negotiate favorable terms in the contract. Apply an understanding of various methods of reimbursement methodology, contract negotiation philosophies, and modeling of financial arrangements to assess impact on Cincinnati Children's. Develop analytical reports that model and demonstrate the financial impact of proposed arrangements for physician, hospital, and ancillary contracts.
  • Communication - Prepare presentations of current and future contracts by keeping logs of arrangements and communicating information to various physicians, business units, and hospital administration. Conduct presentations and market Cincinnati Children's to third party payors. Provide business units with the tools necessary to effectively administer new contract terms and rates as well as changes in third party payor policies.

Qualifications:

EDUCATION/EXPERIENCE

Required:

  • Bachelor's degree in a related field
  • 5 - 7 years of work experience in a related job discipline.


Preferred:

Masters degree in related field

Unique Skills:

Excel skills

Basic knowledge of reimbursement methodology, hospital revenue cycle

Multitasking

Conflict management

Cincinnati Children's is proud to be an Equal Opportunity Employer that values and treasures Diversity, Equity, and Inclusion. We are committed to creating an environment of dignity and respect for all our employees, patients, and families (EEO/AA).



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