We have an exciting opportunity to join our team as a Contract Manager.
In this role, the successful candidate will be responsible for the day to day managed care contract management activities and front and back end and support for all FGP practices, staff including the Central Billing Office and FGP Administration. Partners with internal resources to determine, review and implement appropriate payer reimbursement and administrative policies. Acts as a liaison between managed care payers and the Faculty Group Practice business staff and clinical departments. This role cultivates and manages relationships with practice staff to assist in any administrative issues with payers that may impact their front or back end operations or their ability to process patients through their practice. The Contract Manager plays a key role in assisting the FGP Central Billing Office and any outside billing vendors in bringing resolution to all outstanding billing issues that cannot be resolved through standard channels. Is engaged in the onboarding and transition process of new practices into the FGP. The Contract Manager will work directly with practice staff to train them on proper Epic payer/plans selection for correct patient registration and educate practices on any front-end payer related issues.
Acts as liaison and advocate between FGP practices and Managed Care plans to educate practices about operational policies and procedures impacting the daily operations of the practice.
Educates physician practices and FGP business staff about the terms and conditions of managed care contracts and payment rates with each payer and assists in identifying needed changes to maximize reimbursement and contract compliance
Monitors and tracks ongoing claim resolution activities and other service issues that impact reimbursement. Responsible for keeping all internal parties updated on the status of projects reported by payers.
Reviews health plan policies and procedures on a consistent basis to identify physician and staff educational opportunities, delivers appropriate training, and develops reference materials and communications as needed to ensure all FGP practice operations are in compliance with all payer requirements.
Assists the Vice President and Assistant Director of Compliance and Analytics in any strategic planning and analytical support needed for managed care contracting opportunities
Maintains proficiency in Epic Payer/Plan assists in ensuring that all managed care plans are built correctly and accurately in the system.
Responsible for negotiating single case agreements with payers for out of network services. Should negotiate competitive rates for physician and hospital as needed and clearly communicate and distribute to all necessary parties the final documents and rates.
Performs other duties as assigned and needed to support the Office of Managed Care and Faculty Group Practice.
To qualify you must have a Bachelors Degree or a minimum of three to five years in a physician office, hospital or managed care environment. Proficient in the use of Excel and Word. Knowledge of claims processing systems and guidelines. Ability to analyze problems, draw relevant conclusions, and devises appropriate courses of action. Excellent analytical, interpersonal and organizational skills required.
Masters degree in Health Care, Public Health Administration or Business Administration. One to two years of physician relations experience in an HMO, IPA or large group practice setting. Superior customer service skills.
Qualified candidates must be able to effectively communicate with all levels of the organization.
NYU Langone Health provides its staff with far more than just a place to work. Rather, we are an institution you can be proud of, an institution where you'll feel good about devoting your time and your talents.
NYU Langone Health is an equal opportunity and affirmative action employer committed to diversity and inclusion in all aspects of recruiting and employment. All qualified individuals are encouraged to apply and will receive consideration without regard to race, color, gender, gender identity or expression, sex, sexual orientation, transgender status, gender dysphoria, national origin, age, religion, disability, military and veteran status, marital or parental status, citizenship status, genetic information or any other factor which cannot lawfully be used as a basis for an employment decision. We require applications to be completed online. If you wish to view NYU Langone Health's EEO policies, please click here. Please click here to view the Federal 'EEO is the law' poster or visit https://www.dol.gov/ofccp/regs/compliance/posters/ofccpost.htm for more information. To view the Pay Transparency Notice, please click here.
NYU Langone Health, a world-class patient-centered integrated academic medical center, is one of the nation's premier centers for excellence in clinical care, biomedical research, and medical education. Located in the heart of Manhattan, NYU Langone is composed of four hospitals – Tisch Hospital, its flagship acute care facility; Rusk Rehabilitation; the Hospital for Joint Diseases, one of only fi...ve hospitals in the nation dedicated to orthopaedics and rheumatology; and Hassenfeld Children's Hospital, a comprehensive pediatric hospital supporting a full array of children's health services across the medical center – plus the NYU School of Medicine, which since 1841 has trained thousands of physicians and scientists who have helped to shape the course of medical history. The medical center's tri-fold mission to serve, teach, and discover is achieved 365 days a year through the seamless integration of a culture devoted to excellence in patient care, education and research. For more information, go to www.nyulangone.org.