Sponsor: Rubicon Genomics
Recording Date: 2/19/2014
Recording Time: 1 hour
The Contracting Manager is responsible for facilitating and managing the entire contract life cycle of Private and Government Managed Care contracts. The Contracting Manager will work closely with Field Managed Care in developing and negotiating agreements that provide medical providers and patients with access to our assays while aligning with Genomic Health's goals and objectives. The Contracting Manager is also responsible for facilitating contract implementation with the account and the appropriate internal departments (e.g. finance, customer service, billing and reimbursement teams), monitoring compliance to ensure all parties are meeting their responsibilities pre and post contract initiation, and providing recommendations upon contract renewal.
- Collaborate with the Managed Care team to develop account specific objectives to support the overall, strategic Managed Care business plan.
- Develop contracts/amendments/notifications for Managed Care customers and collaborate with Managed Care team in negotiations with payers.
- Facilitate conversations with appropriate departments early in the contracting process to provide updates, discuss potential operational issues, and develop and follow up on plans to address such issues.
- Develop implementation strategies and pull-through action plans for contracted payers in order to meet quarterly revenue goals.
- In-depth analysis of complex, reimbursement situations and data to identify reimbursement obstacles, and investigate and evaluate the factors impacting revenue pull-through and minimizing obstacles to reimbursement.
- Involved in the development of action plans for payers that are non-compliant with payment or other contractual obligations, and leads the implementation of the plan with all impacted parties.
- Establish and maintain relationships with payers' Provider Relations personnel to facilitate initial contract implementation, resolve any subsequent issues, and continually monitor and improve upon processes.
- Establish tactics, for internal and external parties, in coordinating the execution of implementation and pull-through plans. Work closely with the Reimbursement Manager to prioritize assignments with our external billing/reimbursement partner.
- Assist in the development and ongoing maintenance of boilerplates, including facilitating review with appropriate internal parties and legal.
- Coordinate review of any 'non-standard' contract obligations with appropriate parties.
- Assist with the rollout and tracking of mass communications and/or contracts (e.g. new product, price increase, process change).
- Understanding of market-related issues, contract development, negotiation, and pull through as well as the legal and regulatory implications associated with Private and Government payer contracting
- Effective communication skills, both written and oral
- Collaborative and works effectively as a team member
- Strong attention to detail and organizational skills
- Strong analytical skills and familiarity with Excel and Access (or similar database)
- Ability to present recommendations supported by analytical evaluations
- Capable of prioritizing and managing several, complex projects at once
- Strong skills with Word
- Ability to influence without authority
- Comfortable with web technology / document management systems / account management systems
- Capable of identifying and implementing enhancement opportunities
- BA or BS degree required
- 12 plus years contracting experience within the healthcare industry
- Knowledge of and/or experience with private Managed Care payers and reimbursement process
- Knowledge of and/or experience with government Managed Care payers and reimbursement process is a plus
- Knowledge of billing and coding is a plus
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