Job Summary
The Managed Care and Contracting Office is responsible for the negotiations, implementation and administration of managed care agreements between Michigan Medicine, Sparrow Health System and The University of Michigan Health-West (UMHWest) and a wide range of healthcare delivery options. Negotiations include all aspects of the healthcare delivery system such as, but not limited to: facility, professional, governmental, transplant, Car-T, Cell-gene therapies, ancillary services, Critical Access Hospitals, Specialty Hospitals, Delegated Credentialing, Single Case Agreements (SCAs), etc. Payers/Contract parties are located within the State of Michigan as well as Out of State with the possibility of International Involvement when SCAs are involved. Valuation of financial impact to UMH of contracts have a wide range dependent on contract type, parties to the contracts, financial class, and emerging health care industry developments.
Managed Care Contract Administrators will assist with development, gather, assess, and utilize various financial reports, various payment methodologies, certain market competition analyses, current claims unit price for use in negotiations. Managed Care Contract Administrators will be responsible for contract language review, edits and proposing alternative language and work with the Office of General Counsel to final approved version. During the contract negotiation process, the Managed Care Contract Administrator will be responsible for evaluating financial counter offers, determining economic impact to UMH, and propose acceptable alternative rates. Managed Care Contract Administrators will lead contract negotiations without Senior Director or Chief Contracting Officer involvement for accounts of lesser dollar volume.
Key functions include readiness assessment, market evaluation, strategic planning and contract negotiation. Employees in this classification typically analyze, compare and evaluate various courses of action and have the authority to make independent decisions on matters of significance, free from immediate direction, within the scope of their responsibilities. Primary activities and decision making authority are predominantly performed independently affecting business operations to a substantial degree.
Mission Statement
Michigan Medicine improves the health of patients, populations and communities through excellence in education, patient care, community service, research and technology development, and through leadership activities in Michigan, nationally and internationally. Our mission is guided by our Strategic Principles and has three critical components; patient care, education and research that together enhance our contribution to society.
Responsibilities*
- Establish and maintain professional relationships with payers, contract parties, federal and state entities.
- Development of strategic initiatives that interface with all areas of the company and affect contractual arrangements with providers; Provides subject matter expertise for the development and implementation of provider reimbursement, risk sharing and incentive models.
- Prepares for contract negotiations by performing the following tasks:
- Review current contract prices and exception carve outs.
- Validate charges against costs to establish contract price for negotiations. This may involve engaging with Leadership in Finance, Revenue Cycle, Analytics .
- Involved in conducting advanced analysis of historic costs, utilization for preparedness in negotiations and counter-negotiations.
- Prepares and presents analyses findings and recommendations to Sr. Director and/or Chief Contracting Officer for contracts valued in excess of $500,000 for approval on moving forward with negotiations.
- Responsible for executing necessary agreements and packages for Center of Excellence Programs (COE) which may require coordinating engagement of multiple departments responsible for performance.
- Contract documentation and execution tasks:
- Documents and tracks all aspects of negotiations via track changes and version controls.
- Actively participate in, and/or lead, negotiations offering counter points to negotiation differences from payer.
- Prepare summaries of all modifications to original agreements and engage OGC if substantial changes occur.
- Update and maintain the ?Preferred, Acceptable, Discouraged, Unacceptable? (PADU) template on contract terms.
- Prepare final contract package to be included in Executive Package for signature.
- Responsible for obtaining fully executed agreements (all types).
- Prepare either Contract Configuration Form or Contract Configuration Amendment Form upon fully executed agreements to ensure accurate loading of payer contract to ensure financial viability.
- Update /maintain applicable rates grid which are critical to Revenue Cycle, Payment Integrity, and Finance.
- Update /maintain Contracts Under Review Data, MCCO Report Card for all negotiations.
- Upload fully executed SCAs into MiChart to ensure negotiated rates are collected at time of payment.
- Attend and participate in all Payer Joint Operating Committee Meetings to represent, solve, any/all contracting matters for each locality.
- Lead in coordinating problem resolution on contracting matters escalated, may require outreach to Associate Chief Financial Officers, Chief Revenue Cycle Officer, Finance Department, Registration, Care Management, other departments/individuals as necessary.
- Respond to concerns/questions assigned through the MCCO Departmental Mailbox.
- Resolve contract interpretation issues with insurance payers.
- Participate in various internal meetings representing Managed Care Contracting, providing direction/resolution on contractual matters.
Required Qualifications*
- Minimum 5 years of experience working in a managed care organization, hospital or health system.
- Minimum 3 years of analyses of contract documents, contract financials review, experience in developing/utilizing negotiating tactics and strategies.
- Comprehensive understanding of healthcare regulatory CMS requirements, healthcare reform.
- Strong analytical, organizational, and decision-making skills.
- Undergraduate degree in business, accounting, finance, healthcare administration or related field.
- Masters degree preferred
- Excellent oral and written communication skills and the ability to work effectively across UMH.
- Excellent understanding of Managed Care plans, health insurance concepts, and insurance related functions, processes, and requirements.
- Ability to work both independently and as part of a team environment in a remote/hybrid environment.
- Ability to handle multi-faceted tasks in a fast- paced work environment while maintaining the level of detail critical to contracts.
- Competent utilizing a wide variety of Microsoft Office programs, including but not limited to Microsoft Word, PowerPoint, and Excel.
- Ability to comprehend complex contracts, legal documents, government reimbursement laws and regulations, and business acumen of various healthcare organizations.
- Prefer to have experience with EPIC Electronical Medical Records System.
Modes of Work
Positions that are eligible for hybrid or mobile/remote work mode are at the discretion of the hiring department. Work agreements are reviewed annually at a minimum and are subject to change at any time, and for any reason, throughout the course of employment. Learn more about the work modes.
Background Screening
Michigan Medicine conducts background screening and pre-employment drug testing on job candidates upon acceptance of a contingent job offer and may use a third party administrator to conduct background screenings. Background screenings are performed in compliance with the Fair Credit Report Act. Pre-employment drug testing applies to all selected candidates, including new or additional faculty and staff appointments, as well as transfers from other U-M campuses.
Application Deadline
Job openings are posted for a minimum of seven calendar days. The review and selection process may begin as early as the eighth day after posting. This opening may be removed from posting boards and filled anytime after the minimum posting period has ended.
U-M EEO Statement
The University of Michigan is an equal employment opportunity employer.