Job Details

Managed Care AIC Contracts Manager - Remote

Option Care Health is the largest independent home and alternate site infusion services provider in the United States, with over 8,000 team members including 5,000 clinicians. This role is responsible for the more complex and large account negotiations, preparation, financial analysis, business review, and implementation of assigned Managed Care clients, 340B, and Health System Partnership agreements for home and alternate site infusion services provided by Option Care. Responsible for managed care plans with greater than 250K lives thatrequire more complex negotiation and relationship management. Resolve reimbursement issues arising from contract compliance issues for assigned regions when escalated by Revenue Cycle Management team.

Job Responsibilities

• Manage the negotiation of managed care and health system contracts in accordance with company guidelines for assigned geography for home and alternate site infusion therapy services provided by Option Care
• Oversee internal implementations of assigned agreements with regional intake, operations, and revenue cycle teams in order to insure success of clean claims payment
• Manage external implementations and foster ongoing relationships with assigned accounts
• Manage communication with assigned accounts as it relates to demographic changes to Option Care Facilities to insure health plan agreements are current in order to facilitate clean claim billing
• Initiate and lead meetings with health plans and corporate teams, including Managed Markets and Contracting leadership, to review provider agreement performance data and scorecards. Informs contracting leadership of contract risks for assigned third party contracts. Recommends course of action to reduce/minimize risk to the organization. Identifies, and assesses impact of potential changes in the industry or changes related to new state or federal legislation
• Resolve reimbursement issues identified by Payer Liaisons that may be related to contract compliance
• Strategize with AVP MMS on plans to update and grow a sales representative's understanding of the scope and intent of assigned managed care or facility contracts. Attends client meetings where appropriate and in collaboration with assigned managed markets representative
• Maintains successful working relationships with internal departments such as Infusion Operations, Legal, Sales, and any other departments that are involved with or impacted by managed care contracts
• Complete credentialing applications when necessary for new contract access as back up to contract coordinator
• Participate in regional meetings as directed by VP, Contracting

Supervisory Responsibilities

Not applicable

Basic Education And Experience Requirements

High school diploma and 10 years of experience in managed care account management or contract analysis and negotiation within the health care industry.

Basic Qualifications & Interests (BQIs)

• Experience with contract negotiations involving financial terms for health care services
• Experience in working with managed care clients and familiarity with contract terms and conditions in the ancillary arena
• Experience with analyzing and reporting data in order to identify issues, trends, or exceptions to drive improvement of results and find solutions
• Experience providing customer service to internal and external customers, including meeting quality standards for services
• Experience with Home Infusion or Specialty pharmacy
• Experience with CPR+ preferred
• Experience using time management skills such as prioritizing/organizing and tracking details and meeting deadlines of multiple projects with varying completion dates
• Intermediate level skill in Microsoft Excel (for example: using SUM function, setting borders, setting column width, inserting charts, using text wrap, sorting, setting headers and footers and/or print scaling)
• Intermediate level skill in Microsoft PowerPoint (for example: applying a theme, formatting character spacing, inserting a picture, changing slide layout and theme colors, adding transitions, customizing slide numbers, changing chart style and/or formatting font)
• Intermediate level skill in Microsoft Word (for example: inserting headers, page breaks, page numbers and tables and/or adjusting table columns)

Travel Requirements

Will travel up to 25% of the time for business purposes (within state and out of state).

Preferred Qualifications & Interests (PQIs)

• Bachelor's degree and 5-8 years of experience in contract management and negotiation within the health care industry (preferably home infusion or specialty pharmacy).

Additional Notes

This job description is to be used as a guide for accomplishing Company and department objectives, and only covers the primary functions and responsibilities of the position. It is not intended to be an all-encompassing list of duties. Due to state pay transparency laws, the full range for the position is provided below. Salary to be determined by education, experience, knowledge, skills, and abilities, as well as internal equity and alignment with market data. Pay Range is $84,824.86-$141,382.26

Benefits

• Medical, Dental, & Vision Insurance
• Paid Time Off
• Bonding Time Off
• 401K Retirement Savings Plan with Company Match
• HSA Company Match
• Flexible Spending Accounts
• Tuition Reimbursement
• myFlexPay
• Family Support
• Mental Health Services
• Company Paid Life Insurance
• Award/Recognition Programs

Option Care Health is an equal opportunity employer. We are committed to an inclusive workplace free from discrimination based on race, color, religion, national origin, citizenship status, sex, sexual orientation, gender identity, age, disability, veteran status, or genetic information, in accordance with applicable laws.

Seniority level

Not Applicable

Employment type

Full-time

Job function

• Management and Manufacturing

Industries

• Hospitals and Health Care