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Responsibilities

• Plan, strategize, and oversee daily operations of Balance Billing & Fee Negotiation, and Contracting units.
• Manage the Balance Billing & Fee Negotiation unit, handling NSA and IDR negotiations, and other member balance billing issues.
• Oversee and negotiate rates for out-of-network hospital and medical services.
• Manage contracting activities with all facility types, vendors, and ancillary providers, ensuring contract compliance.
• Maintain contract documents, including professional agreements, letters of agreement, and amendments.
• Ensure all contract template changes are approved by the Legal Department.
• Facilitate contract rate and terms negotiation within financial and operational goals, capturing and reporting key metrics.
• Collaborate with outside fiduciaries to implement rates for inpatient and outpatient hospital services.
• Respond to provider issues and concerns to effectively manage high-volume hospitals, vendors, and networks.
• Manage staff according to department procedures, HR guidelines, and Collective Bargaining Agreement provisions.
• Act with integrity, communicate with candor, and honor commitments.
• Demonstrate passion for members, set high expectations, and collaborate with other departments to refine workflows.
• Perform additional duties and projects as assigned.

Requirements

• Minimum six (6) years of relevant experience in managed care, contracting, and network management.
• Four (4) years of supervisory experience required.
• Knowledge of fee negotiations, reimbursement methodology, and contract language review.
• Broad knowledge of applicable laws, regulations, and protocols (ERISA, DOL, HIPAA, PHI, ACA).
• Excellent written, organizational, and communication skills.
• Detail-oriented with strong interpersonal and team-building skills.
• Knowledge of hospital and medical claims adjudication, medical billing and coding terminology, and Medicare/industry billing policies.
• Proven multi-tasking skills and ability to meet critical deadlines.
• Intermediate proficiency in Microsoft Suite/365, Word, and Excel.

Skills

• Managed care
• Contracting
• Network management
• Fee negotiations
• Reimbursement methodology
• Contract language review
• ERISA
• DOL
• HIPAA
• PHI
• ACA
• Written communication
• Organizational skills
• Interpersonal skills
• Team building
• Claims adjudication
• Medical billing
• Coding terminology
• Microsoft Suite/365
• Microsoft Word
• Microsoft Excel

Experience Level

• Minimum six (6) years relevant experience
• Four (4) year supervisory experience

Education Level

• Bachelor’s degree in business or health related field
• Master’s Degree preferred