Job Description

SALARY RANGE: $161,500.00 - $218,500.00

DISTINGUISHING FEATURES OF THE CLASS: The work involves planning, coordinating, directing, and managing the day-to-day relationships with local and non-local health insurance and managed care plans at the Erie County Medical Center Corporation (ECMCC). The incumbent establishes and maintains relationships with health insurance plan leaders, develops and implements strategies, short and long-term goals, objectives and action plans for the Managed Care Department, with the intended outcome of directly contributing to the revenue growth, earnings performance, and achievement of strategic objectives at ECMCC. The work is performed under the general direction of the Chief Financial Officer. Supervision is exercised over lower-level administrative and professional staff. Performs related work as required.

TYPICAL WORK ACTIVITIES:

Works collaboratively with ECMCC leadership to develop and implement the Managed Care contracting strategies, contracts, renewals and alternative payment models which serve as the basis for Managed Care activities;

Leads the ECMCC Managed Care negotiating team;

Develops and coordinates payer contract strategies and develops and manages payer relationships;

Works collaboratively with others within the Finance Department to develop and produce financial

forecasts designed to meet/exceed revenue and earnings objectives;

Implements processes and communication strategies for decision-making to include active involvement of ECMCC leadership and key stakeholders;

Collaborates with Executive Management, Medical Staff and Service Line Leadership to identify and coordinate strategies and action plans designed to increase revenue and meet earnings growth objectives;

Works closely with ECMCC counsel on modifying contract language and terms and conditions to align with ECMCC practices;

Communicates and regularly collaborates with the Utilization Management department on authorizations and payer practices, policies and procedures;

Regularly interacts with Revenue Cycle, Case Management and Health Information personnel on notifications, denials, documentation and appeals;

Develops and maintains contacts with federal, state and local agencies associated with Managed Care;

Ensures compliance with federal, state and local regulations and rules as they relate to Managed Care;

Manages portfolio of Managed Care contracts and associated revenue to meet/exceed ECMCC business objectives;

Evaluates and reports on status of goals and objectives in relation to established Managed Care contracting renewals and other activity;

Identifies Managed Care growth opportunities by researching and evaluating the market, contracts and other applicable factors to increase market share, maximize revenues and meet/exceed overall business goals and objectives;

Monitors industry trends and potential changes to federal, state and local regulations and rules as they relate to healthcare;

Develops, tests and implements value-based Managed Care contracts and associated reimbursement methodologies (“non-FFS”) by closely working with Population Health personnel and Great Lakes Integrated Network (GLIN), ECMCC’s Clinically Integrated Network;

Collaborates with legal and/or regulatory partners to achieve a high-level of compliance;

Develops and administers presentations to internal and external audiences;

Participates in activities related to the Great Lakes Integrated Network (GLIN) as assigned;

Regularly interacts with credentialing and re-credentialing personnel and ensures all documentation related to facility credentialing is up to date and current;

Negotiates Single Case Agreements (SCA) for patients who are associated with payers not contracted with ECMCC;

Attends required meetings, participates in committees as required and maintains membership in professional organizations.

FULL PERFORMANCE KNOWLEDGE, SKILLS, ABILITIES AND PERSONAL CHARACTERISTICS: Thorough knowledge of the principles, practices and terminology in the field of health care administration; thorough knowledge of the principles, practices and terminology of Managed Care administration including contracting and payer reimbursement; thorough knowledge of federal, state and local regulations and rules as they relate to Managed Care; ability to plan, implement and evaluate financial and business objectives; ability to prepare and present complex comprehensive financial reports; ability to conduct negotiations; ability to manage multiple priorities; ability to organize, direct and evaluate work of assigned staff; ability to communicate effectively both orally and in writing; ability to maintain effective working relationships with third-party payers, ECMCC management and staff, physicians, public and private organizations, etc.; ability to use a variety of software applications; strategic and tactical thinking; sound professional judgment; leadership; initiative; positive attitude, confidentiality; capable of performing the essential functions of the position with or without reasonable accommodation.

MINIMUM QUALIFICATIONS:

1. Possession of a Master’s Degree* in Business, Public or Hospital Administration or closely related field and seven (7) years of healthcare experience, of which five (5) years must include experience with Managed Care contracting; or
2. Possession of a Bachelor’s Degree* in Business, Public or Hospital Administration or closely related field and nine (9) years of healthcare experience, of which five (5) years must include experience with Managed Care contracting.

NOTE *: Your degree must have been awarded by a college or university accredited by a regional, national, or specialized agency recognized as an accrediting agency by the U.S. Department of Education/U.S. Secretary of Education. If your degree was awarded by an educational institution outside the United States and its territories, you must provide independent verification of equivalency. A list of acceptable companies who provide this service can be found on the Internet at http://www.cs.ny.gov/jobseeker/degrees.cfm You must pay the required evaluation fee.

NOTE 2: Verifiable part-time and/or volunteer experience will be pro-rated toward meeting full-time experience requirements.