Vista Community Clinic

  • Payer Relations and Contract Administration Manager

    Req No.
    2018-1863
    Location
    US-CA-Vista
    Type
    Regular Full-Time
    Department
    Finance
  • Overview

    Payer Relations and Contract Administration Manager

     

    Vista Community Clinic, a Federally Qualified Health Center providing a wide array of healthcare services and community health programs in the cities of Vista, Oceanside, Lake Elsinore, and La Habra California, is looking for an experienced managed healthcare professional to join our team. This new position will serve as the key contact with contracted Managed Care Plans in the 3 counties that we serve, ensuring that contracts are implemented effectively and working to ensure that strategies for the maximization of managed care revenues are realized.

    Responsibilities

    Ongoing responsibilities will include:

    • Manage staff
    • Monitor managed care plan agreements and manage and tracks incentive opportunities, IHA/AHA, Plan adds and drops, and gaps in care
    • Coordinate actions with internal department teams to maximize managed care incentive revenue, working closely with Operations, Compliance, and Quality
    • Serves as the liaison to any Accountable Care Organizations that the organization participates in; works with staff to maximize ACO performance
    • Serves as the “point person” to contracted managed care plans. Responsible for maintaining continuous communication with the managed care vendor(s) to insure all service program expectations are identified and maintained, managing questions/issues from internal and external users relating to managed care programs and processes
    • Carries out appropriate managed care related education and training, including the roll out and implementation of new payer contracts; and assures that new contracts are implemented in a timely and accurate manner.
    • Work with billing/coding staff to maximize provider coding and RAF scores
    • All other duties as assigned

    Qualifications

    The ideal candidate will have the following background and experience:

    • College degree in a Business or Healthcare related field preferred
    • Five years experience in revenue cycle management is required
    • Two years supervisory experience is required
    • Three years of managed care plan and/or contract administration experience is required
    • Proficiency with computer systems and Microsoft Office (Word, Power Point, and Excel) required
    • Successful candidates will thrive in a fast paced, rapidly changing environment

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