Summary: Supports the Payor Contracting department in coordinating and implementing Parkview Health's third party payor contracting strategy and may assist with contract negotiations. Reviews contracts and provides alternate language to ensure compliance with Parkview contracting standards. Responsible to manage the ancillary contracting for various Parkview Health service lines including but not limited to Parkview Behavioral Health, Parkview Health Labs, Parkview Home Health and Hospice, Parkview Physicians Group (PPG) and Skilled Nursing Facilities. Acts as liaison between Parkview Health and third party payors to resolve operational issues including erroneous payments. Ensures compliance of third party agreements relative to licensure and credentialing.
Education: Baccalaureate degree in healthcare or business administration or the equivalent of 8 years additional experience in a comparable job.
Experience: Minimum of two years experience in managed care arena with one year of experience negotiating contracts. Must have functional experience in Microsoft Office products. Has direct experience with health care classification and coding methods including but not limited to DRG classifications Revenue Codes CPT coding and CMS reimbursement methodologies. Must have demonstrable knowledge of contract language reimbursement terms and operations relative to third party payor relationships. Must possess strong verbal and written communication skills. Ability to manage multiple and varied assignments with minimal oversight.