Lead Contracting Specialist LGH (40 hours/week)
1.0 FTE, Monday - Friday, no Weekends or Holidays, Schedule hours flexible to Employee needs, Position if Full-time Remote.
POSITION SUMMARY: Support the Director of Contracting with all fee-for-service and advanced payment model managed care contracting responsibilities including management of documents, implementation and monitoring of terms, preparation of facility credentialing, analysis of reimbursement and performance data, preparation of reports and executive summaries, and participation during negotiations with third party payers requiring regular interaction with management and executives of both parties.
HOURS: Full Time day shift Monday-Friday. Schedule/hours are flexible to employee needs.
ESSENTIAL FUNCTIONS: Qualified individuals must have the ability (with or without reasonable accommodation) to perform the following duties:
- Acts in a leadership role with respect to third party payer relationships by acting at primary point of contact for day-to-day fee-for-service (FFS) contract discussion and issues. Builds strong relationship and facilitates productive communication between key stakeholders and third party payers.
- Represents the Director as escalation resource on assigned material contract issues unresolved by the efforts of the Contracting Specialists.
- Coordinates communication related to FFS contracts with all relevant parties including staff, management, and executives of both LG Health and the third party payers.
- Participates in negotiation of all FFS third party payer contracts and value based contracts as appropriate.
- Conducts negotiations of payer contracts as assigned by Director.
- Maintains thorough understanding of all reimbursement methodologies including case rate, fee for services, quality incentives, shared savings, and profit/loss sharing.
- Works with various revenue cycle stakeholders and third party payers to ensure timely and appropriate resolution of issues as appropriate.
- Conducts managed care contracting training for newly hired Contracting Specialists and provides ongoing education for revenue cycle teams.
- Maintains records of all executed fee-for-service and advanced payment model managed care contracts between Penn Medicine Lancaster General Health entities (Lancaster General Hospital, Lancaster General Medical Group, Twin Rose Family Medicine, The Heart Group Lancaster General, Lancaster General Health Community Care Collaborative, etc.) and third party payers.
- Utilizes workflow management systems for approval and execution of contracts in compliance with the policies of Legal Services.
- Implements and maintains EPIC, nThrive, and Experian reimbursement contract structures through build/design requests to Information Services and Vendor System Administrators.
- Communicates fee-for-service reimbursement terms to Patient Financial Services and Professional Billing Services
- Collaborations with the team on implementation of advanced payment model terms and monitoring of performance including presentations to executives and physicians.
- Analyzes reimbursement and performance data to support negotiations with third party payers.
- Ensures that appropriately completed insurance credentialing applications are submitted to contracted payers for Lancaster General Hospital in a timely fashion.
SECONDARY FUNCTIONS: The following duties are considered secondary to the primary duties listed above:
- Other duties as assigned.
MINIMUM REQUIRED QUALIFICATIONS:
- Bachelor’s degree in Business Administration or related field or equivalent combination of education and work experience.
- Eight (8) years of contract software/analysis experience.
- Eight (8) years of experience with revenue cycle processes and procedures, financial analysis, cost accounting, or decision support experience in the healthcare field.
- Proven analytical and attention to detail skills.
- Self-motivated and self-directed.
- Demonstrated ability to recognize data problems and follow-up analysis.
- Strong communication skills, ability to question freely, and work with all levels of management and clinicians.
- The ability to manage multiple tasks simultaneously, maintain attention to detail and adjust to issues as needed in a dynamic work environment. The ability to prioritize and effectively anticipate and respond to issues as they arise.
- Eight (8) years’ experience conducting meetings and preparing status reports.
- Working knowledge of system and data requirements, financial management and health care reporting.
- Knowledge and experience working with data analysis tools, patient accounting systems and office programs such as Microsoft Access and Excel.
Disclaimer: This job description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills, efforts, or working conditions associated with the job. It is intended to be a reflection of those principal job elements essential for recruitment and selection, for making fair job evaluations, and for establishing performance standards. The percentages of time spent performing job duties are estimates, and should not be considered absolute. The incumbent shall perform all other functions and/or be cross-trained as shall be determined at the sole discretion of management, who has the right to amend, modify, or terminate this job in part or in whole. Incumbent must be able to perform all job functions safely.
PENN MEDICINE LANCASTER GENERAL HEALTH offers the following benefits to employees:
- 100% Tuition Assistance at The Pennsylvania College of Health Sciences
- Paid Time Off and Paid Holidays
- Shift, Weekend and On-Call Differentials
- Health, Dental and Vision Coverage
- Short-Term and Long-Term Disability
- Retirement Savings Account with Company Matching
- Child Care Subsidies
- Onsite Gym and Fitness Classes
Posted on 09/06/2023
PENN MEDICINE LANCASTER GENERAL HEALTH is an Equal Opportunity Employer, committed to hiring a diverse workforce. All openings will be filled based on qualifications without regard to race, color, sex, sexual orientation, gender identity, national origin, marital status, veteran status, disability, age, religion or any other classification protected by law.
Search Firm Representatives please read carefully: PENN MEDICINE LANCASTER GENERAL HEALTH is not seeking assistance or accepting unsolicited resumes from search firms for this employment opportunity. Regardless of past practice, all resumes submitted by search firms to any employee at PENN MEDICINE LANCASTER GENERAL HEALTH via-email, the Internet or directly to hiring managers at Penn Medicine Lancaster General Health in any form without a valid written search agreement in place for that position will be deemed the sole property of PENN MEDICINE LANCASTER GENERAL HEALTH, and no fee will be paid in the event the candidate is hired by PENN MEDICINE LANCASTER GENERAL HEALTH as a result of the referral or through other means.