AIC Contracts Manager - Remote

Option Care Health•Nashville, TN

2d•$78,973 - $131,615•Remote

About The Position

The Ambulatory Infusion Centers (AIC) Contracted Manager role is a key contributor and is responsible for payer relationship management, negotiations, preparation, financial analysis, business review, and implementation of payer agreements for AIC services provided by Option Care. Actively resolves reimbursement issues arising from contract compliance issues when escalated by Revenue Cycle Management team and obtains payer fee schedules as needed for Option Cares payer systems.

Requirements

High school diploma and 5 yrs of experience in managed care account management, contract analysis or administration, or with managed care payers through patient registration or revenue cycle in the health care industry.
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 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).
Willing to travel up to 25% of the time for business purposes (within state and out of state).

Nice To Haves

Bachelor's degree and 3-5yrs of experience in managed care contract management within the health care industry.
Experience with CPR+ preferred

Responsibilities

Manage AIC contracting activities with payers: Request payer agreement within 5 days of any applicable Medicare, Medicaid or payer credentialing completion, otherwise 5 days of payer being targeted for contract. Ensure payer agreement rates are in accordance with AIC services standards provided by Option Care leadership, negotiate, if possible, if not coordinate with AIC leadership on desire to move forward with agreement. Informs contracting leadership of contract risks for payer contracts. Recommends course of action to reduce/minimize risk to the organization.
Monitor and follow up as needed for progress of contract requests, including but not limited to: Payer status updates and dually executed copy every 14 days or as outlined by payer timeline. Internal business area updates, such as legal, pricing, credentialing, and leadership, every 7 days or smaller window of time that may be needed to ensure Docusign link does not expire.
Ensure successful internal implementation of Agreements: Obtains payer fee schedule. Collect claims submission information. Submits WeInfuse or CPR+ (TN only) add payer service now ticket within 5 days of confirmation agreement and nurse practitioners are loaded in payers system.
Manage external implementations and foster ongoing payer relationships: Assist credentialing team as needed with agreement confirmations, payer escalations for payer load issues within 5 days or receipt of issue. Obtain new fee schedules quarterly or schedule followed by specific payer.
Initiate and lead meetings: with health plans with corporate teams, including AIC Market Operation Directors, RCM, Credentialing, Legal.
Resolve reimbursement issues identified by Payer Liaisons that may be related to contract compliance: Review payer website for clinical policy updates as needed Obtain payer rates for reimbursement issue Provide guidance on service path to payment.
Participates and supports strategic discussions with AIC VP and AIC Directors of Operation on plans to update and grow. Reviews existing contracting strategy per market annually, updates strategy upon request at any time throughout the year Constructs a market strategy for new markets, reviews new strategy with AIC VP and AIC Directors of Operation for input and then executes on plan.
Meet network growth targets as outlined by leadership.
Maintains successful working relationships with internal departments such as: AIC Leadership Legal & Licensing RCM EDI