About Us
- Ventra is a leading business solutions provider for facility-based physicians practicing anesthesia, emergency medicine, hospital medicine, and now radiology, through the recent combining of forces with Advocate RCM. Focused on Revenue Cycle Management and Advisory services, Ventra partners with private practices, hospitals, health systems, and ambulatory surgery centers to deliver transparent and data-driven solutions that solve the most complex revenue and reimbursement issues, enabling clinicians to focus on providing outstanding care to their patients and communities.
Job Summary
- Under administrative direction, this position oversees the Managed Care Department for assigned business units. You will be responsible for oversight, coordination and negotiation of contracting activities for our clients and Managed Care department. Provides regular feedback to Ventra Vice President of Payer Strategy & Contracting and Client Services team.
Essential Functions and Tasks
- Manages Managed Care Department operations: recruits, orients, trains, coaches, counsels, and disciplines staff. Plans, monitors, appraises, and reviews staff job contributions. Implements cross functional training and succession planning as allowable.
- Makes recommendations regarding contract rates and payer contracting strategy to VP of Payer Strategy & Contracting.
- Manages contract cycle for all agreements with current and prospective payers across multiple regions and assigns work to Contracting Specialists. Prioritizes decision making on payer related issues. Analyzes all payer issues and find a timely solution.
- Identifies opportunities to improve Client’s financial performance through payer negotiations and communicates the status of payer negotiations to appropriate stakeholders.
- Manages payer negotiation projects which may require research such as new specialties, new states, startups, entity changes, etc.
- Represents Ventra in meetings and negotiations with Clients and payers regarding all aspects of payer contracts.
- Reviews and assists in contract modeling and dashboard reporting.
- Consistently demonstrates capacity to manage and resolve urgent issues that arise.
- Conducts Out of Network Payer Performance Reviews for potential new contracting opportunities
- Performs special projects and other duties as assigned.
Education and Experience Requirements
- High School Diploma or GED.
- Bachelor’s degree in healthcare management, Business, or related field preferred or equivalent training and/or experience.
- At least five (5) years of experience working with managed care in a medical or insurance setting. Previous supervisory or management experience preferred.
Knowledge, Skills, and Abilities
- Knowledge of State, Federal, and Managed Care regulatory guidelines.
- Knowledge of benefit insurance billing contract management.
- Strong supervisory/management skills.
- Strong management level oral, written, and interpersonal communication skills.
- Strong word processing, spreadsheet, database, and presentation software skills.
- Strong mathematical skills in addition, subtraction, multiplication and division of whole numbers and fractions; computing percentages, areas, and volumes; and working with decimals.
- Strong decision-making skills.
- Strong problem-solving skills.
- Strong process improvement skills.
- Strong strategic thinking skills.
- Strong negotiation skills.
- Ability to read, understand, and apply state/federal laws, regulations, and policies.
- Ability to persuade and influence.
- Ability to exercise sound judgment and handle highly sensitive and confidential information appropriately.
- Ability to remain flexible and work within a collaborative and fast paced environment.
- Ability to communicate with diverse personalities in a tactful, mature, and professional manner.
- Ability to exercise sound judgment and handle highly sensitive and confidential information appropriately.
- Ability to initiate and maintain professional relationships.
- Strong knowledge of Outlook, Word, Excel (pivot tables), and database software skills.
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