- Build and maintain strong positive and respectful relationships with the network representatives associated with each contracted MCO.
- Assure the USAP General Counsel’s office has copies (scanned documents acceptable) of fully-executed agreements and amendments for each MCO with which USAP is contracted.
- Help drive the NCR performance of each commercial MCO agreement (excluding leased network agreements to at least 98% (NCRRCM) and 95% (NCRASA) and where such metric targets are not met, then confirm the variance, identify the root cause of the variance, and define and report steps to either correct the variance or mitigate the variance via pricing alternatives.
- Monitor payer notices describing changes in its policies, procedures or protocols which would result in a reduction in payment to USAP or could be reasonably construed to significantly increase USAP’s administrative costs, working collaboratively with RCM to assess those impacts and initiate written objection to the payer as permitted in accordance with USAP’s participation agreement.
- Monitor significant shifts in coverage for major employers from one insurer to another which could have a significant impact (positive or negative) on USAPs local contracting economics.
These key responsibilities are to be achieved via your:
- Reporting, formulating and implementing processes and projects to positively influence established contract performance metrics.
- Offering guidance concerning the elimination of operational defects.
- Identifying and reporting opportunities for the simplification and standardization of each MCO agreement’s contract administration terms.
- Developing close working relationships and providing a supporting role to RCM staff in its monitoring, evaluating and communicating changes in MCO administrative or payment policies and protocols.
- Conducting and coordinating scheduled quarterly face-to-face, meetings with select high-profile and/or high-volume MCOs on behalf of USAP to support and enhance the operational relationship with each contracted MCO.
- Providing guidance and recommendations to the USAP EVP Payer Contracting and USAP senior business managers anticipated to improve MCO contract administrative terms and any related USAP payer performance metric for both new contracts and contract remediation.
- Participates in USAP supported committees to ensure consistent information flow and adequate communication to all necessary entities.
- Maintains and promotes strict confidentiality of PHI and MCO contract terms, including but not limited to compensation terms, reporting known compromise of same to appropriate manager in accordance with company policy.
- Participates in professional development efforts to ensure currency in managed care reimbursement trends.
- Works closely with USAP’s EVP Payer Contracting, the senior practice leadership, payer representatives, RCM staff and practice managers to foster and maintain exceptional levels of customer service and cooperation and to assist in achieving defined financial and operational objectives.
- Microsoft Office products, particularly, Microsoft Word, Excel and PowerPoint applications, as well as adequate working knowledge of reporting software, including but not limited to PowerBI, Tableau, Looker and other applications required to expertly support the analysis of root cause variances in a payer’s USAP Payer Performance Metric vs. that Metric’s Best in Class.
- Five years of experience working in a payer or provider relations role, with demonstrated experience in successfully operationalizing and administering managed care contracts and payer relationships. Must be able to manage multiple projects simultaneously in a highly-matrixed organization, have an exceptionally strong customer service focus, and superb organizational and communication skills. College degree is strongly preferred, but not required.
We are proud of our inclusive people culture that supports our associates to perform at their best. USAP is an equal opportunity employer. Candidates with physician services or related health care experience is a plus. We offer a competitive benefits package.
U.S. Anesthesia Partners (USAP) is the largest single-specialty anesthesia practice in the country with over 4,000 clinical providers and associates. By joining our team you will participate in a highly collaborative and dynamic environment. As an organization we are mission focused on delivering the highest quality in patient care and you will be directly supporting our talented clinical team. We extend this same commitment to quality to our associates and supply tools and resources that will ensure we win in the healthcare marketplace and support of USAP.