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J201165

Manager Contract Compliance and Payment Variance

Allegheny Health Network

  • Company AHN
  • Home, PA
  • Finance
  • Full time
  • Day (United States of America)

Company :

Allegheny Health Network

Job Description : 

GENERAL OVERVIEW:

This job supports the Managed Care Department in contract negotiations, contract compliance, and reimbursement analysis. Collaborates with key stakeholders with regard to payor policies and revenue impact of payor expected reimbursement.

ESSENTIAL RESPONSIBILITIES:

  • Perform management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.  Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority. (20%)
  • Manages all aspects of Managed Care related reporting including underpayments, reimbursement analysis, modeling analysis for negotiations and contract performance, and pay for value. (40%)
  • Provides direction and leadership to Managed Care staff. (15%)
  • Manages maintenance of the contract management system. (10%)
  • Administers negotiation of SCAs, payor credentialing, and vendor management. (10%)
  • Collaborates with Revenue Cycle, Finance, and other departments to provide information on payor policies, contract interpretation, and reimbursement analysis requests. (5%)
  • Other duties as assigned.

QUALIFICATIONS:

Minimum

  • Bachelor's degree in Finance, Business, or Healthcare Administration
  • 5 years in Health Care: Provider or Insurance
  • 5 years in Financial Analysis
  • 3 years in Healthcare Reimbursement
  • 1 year in Leadership or Management
  • Strong critical thinking, problem-solving skills and attention to detail
  • Substantial organizations skills including managing multiple priorities
  • Reliable customer service and communication skills
  • Continuously searches for process improvements to achieve accuracy and efficiencies
  • Proficient excel capabilities
  • Ability to analyze data, anticipate requests, and draw conclusions ​

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.


As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. 

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability. 

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf )

We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.

For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

California Consumer Privacy Act Employees, Contractors, and Applicants Notice


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