Manager Of Contracts

Job Description
Manages payor contracting admin duties including payor contracting cycle (new and amended)
Rolls out new and amended payer contracts and/or payer policies to RCM and Operations and audits for compliance
Manages payor notifications distribution, action items and proper storage
Manages notifications from Amerita to payors such as address changes and location updates to contracts
Oversees the systems team that completes the loading and maintenance of payors and pricing in the billing system (CPR+)
Oversees the systems team that manages the CPR+ admin duties including user privileges, popup menus, company, and site setup
Oversees the systems team that manages the clearing house (Zirmed) admin duties including user privileges, payor setup, payor rejections, patient statements
Assist with identification of internal system load issues and provide guidance to the Systems Analyst team on potential corrections
Reads and interprets payor contract and amendment language to identify required, acceptable, and unacceptable contract terms
Consults with Operations, Sales, Managed Care, Revenue Cycle Management, and Legal regarding questionable contract language
Coordinates language review with Financial Planning and Analysis department review of payor pricing
Provides payer negotiation support to Managed Care
Provides ongoing support to Intake and operations to ensure that provider profiles are loaded correctly and remain up to date to reflect correct network status on benefit verification calls
Reviews discrepancies from Intake verification calls to identify contract limitations or issues requiring payor intervention for correction
Provides Intake with interpretation of payor guidelines and policies as needed to ensure appropriate acceptance or rejection of complex referrals
Provides ongoing interpretation of contracts and payor guidelines to Billing to ensure claims are submitted accurately
Provides ongoing interpretation of contracts and payor guidelines to Collections to assist with effective resolution of open balances
Assists with auditing of credit balances to identify and correct overpayment trends
Takes adjustments for payments that are correct based on the contract and payor policies
Assists with auditing of open balances to identify denial trends or consistent payment delays
Reviews submitted adjustments to verify accuracy and identify possible claims trends requiring payor intervention
Assists Collections with “root cause analysis” to identify and correct the sources for claims trends through clean claims analysis and by other means
Coordinates claims projects and discrepancy escalation with Managed Care as assigned
Other duties as assigned