Managed Care Contract Administrator

At Memorial Hermann, we're about creating exceptional experiences for both our patients and our employees. Our goal is to provide opportunities for our diverse employee population that develop and grow careers in a team-oriented environment focused on patient care.

Every employee, at every level, begins their journey at Memorial Hermann learning about the history of the organization and its established culture built on trust and integrity. Our employees drive this culture, and we want you to be a part of it.

Job Summary
Position is responsible for negotiating, monitoring and managing the operations of assigned managed care contracts for Memorial Hermann.

Job Description

The Managed Care Contract Administrator will be responsible for Physician Group and Facility contracting.

Desired Skill Set:

• 3-5yrs experience in Managed Care
• Physician Group and Facility contracting experience highly preferred
• Strong negotiation skills
• Working knowledge of Excel
• ACO (Accountable Care Organization) contracting experience a plus
• Strong financial analytical skills
• Knowledge of Medical methodology
• Knowledge of Healthcare methodology
• Strong Communication skills - Work with senior leadership

Minimum Qualifications

Education: Bachelors degree in Business, Marketing, Healthcare Administration, or related field preferred. In lieu of degree, relevant work experience will be reviewed.

Licenses/Certifications: (None)

Experience / Knowledge / Skills:

• Three (3) to five (5) years experience in managed care contracting either from the provider or the payor side. In lieu of the Bachelor's degree referenced above, ten (10) years' relevant experience is acceptable.
• Strong interpersonal and communication skills
• Excellent presentation skills
• Demonstrates commitment to the Partners-in-Caring process by integrating our culture in all internal and external customer interactions; delivers on our brand promise of "we advance health" through innovation, accountability, empowerment, collaboration, compassion and results while ensuring one Memorial Hermann.

Principal Accountabilities

• Monitors operational compliance of assigned managed care agreements.
• Develops and maintains effective working relationships with insurance company and managed care company personnel responsible for contracting with healthcare providers.
• Negotiates managed care contracts including language, rates, amendments, etc. and monitors financial performance maximizing opportunities for net revenue improvement, volume/growth, and effectiveness of collection efforts.
• Assists in the development and implementation of new reimbursement mechanisms for managed care contracts such as case rates, package or global pricing rates, medical diagnosis categories, capitation, etc.
• Assists in the development and implementation of new types of structural contracting mechanisms such as alliances, subcontracts and contractual joint ventures which will benefit Memorial Hermann in securing managed care contracts.
• Assists Memorial Hermann physicians in their relations with managed care companies and coordinates communications between managed care companies and physicians.
• Obtains managed care agreements and assists Memorial Hermann ancillary companies in their relations with managed care companies.
• Maintains close liaison with payors, Memorial Hermann ancillary providers, Memorial Hermann joint venture partners, and all supporting hospital system departments (e.g. Patient Business Services, Medical Management, Patient Access, Decision Support, etc.).
• Acts as the Memorial Hermann representative for inquiries from patients, providers, and managed care companies regarding claims issues and special negotiated services.
• Ensures safe care to patients, staffs and visitors; adheres to all Memorial Hermann policies, procedures, and standards, within budgetary specifications, including time management, supply management, productivity, and accuracy of practice.
• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education, skills competency, supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor, and resource to less experienced staff.
• Other duties as assigned.