MANAGED CARE OPERATIONS MANAGER

H. Lee Moffitt Cancer Center

Tampa, FL

Job posting number: #7110806 (Ref:hlj_40080)

Posted: September 16, 2022

Application Deadline: Open Until Filled

Job Description

Position Highlights:

The Manager, Payer Strategies Operations is responsible for providing operational oversight and leadership within the Payer Strategies Team. Responsibilities include, but are not limited to, the management of: contractual rate updates within internal systems and the distribution of same; physician and hospital credentialing processes; Letter of Agreement process; project management needs associated with payer policies; the monitoring and escalation of payer issue tracking process; general Payer Strategies projects and efforts in support of the organization’s payer, managed care and employer strategy, business and financial plans. This position requires extensive knowledge of and experience in both commercial and governmental managed care network agreements, payer strategies and reimbursement methodologies associated with hospital, physician and transplant contracts. The Manager of Payer Strategies Operations will also be responsible for the coordination of internal and external events hosted by Payer Strategies.

 

Ideal Candidate:

  • Demonstrated background in evaluating, monitoring, and improving processes. Proven ability to resolve managed care revenue cycle related issues.    
  • Exhibit an excellent ability to grasp operations and business issues quickly, strong analytical problem solving and decision making skills, exercise sound judgment and provide practical and constructive advice in a time-sensitive, dynamic and fast paced complex organizational environment.
  • Demonstrate a thorough understanding of reimbursement methodologies and State/Federal Regulations, and their impact on internal systems and other departments.
  • Understanding of principles of Finance, Accounting and Management with excellent analytical capabilities to support financial planning and budget management.
  • Ability to build and maintain strong business relationships with internal and external clients including third party payers and employers.
  • Accomplished professional able to work independently using critical thinking skills/organizational and administrative skill
  • Ability to read, analyze, and interpret contracts, policies, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from staff, peers, leadership and customers.
  • Excellent interpersonal, problem solving, and leadership skills together with excellent verbal and written communication skills.
  • Strong experience with Microsoft Applications including Excel, Word, PowerPoint and Outlook software. The best candidate will also have experience with revenue cycle systems.
  • Knowledge of the maintenance required in a contract management module, including but not limited to Soarian Financials.
  • Ability to process and understand complex information related to working in a managed care and revenue cycle environment.
  • Development and implementation of departmental processes and Policies and Procedures for efficient day to day payer contracting support.
  • Evaluates and understands contractual language as it relates to hospital and physician reimbursement methodologies.
  • Applies detailed understanding of medical coding systems affecting the adjudication of claims to include ICD-9/10, CPT, HCPCS II, DRG, fee schedules, and revenue codes
  • Demonstrates proficiency with various commercial and governmental reimbursement methodologies, including, Per Diem, DRG, Medicare, Medicaid, payer fee schedules, carve outs, bundles and percent of charges
  • Demonstrates independent thinking, technical expertise, and creativity in development of contract models, standard reports and ad hoc analyses
  • Experience in payer contract administration, compliance and performance including process redesign, technology implementation and project management.
  • Maintains and utilizes available resources to ensure work is completed accurately and timely
  • Provides training to team members as needed.
  • Technological aptitude and ability to learn new technologies or systems, including understanding the functionality of current systems and downstream impacts.

 

Responsibilities:

  • Manages "run-the-business (RTB)" operations and serves as lead on behalf of the team
  • Manages process and projects
  • Supports Human Resources functions
  • Manages Soarian contract modeling and contract administration process to ensure performance, compliance and minimal issue
  • Oversees the Center's standard Letter of Agreement (LOA) process
  • Supervises payer credentialing functions

 

 

Credentials and Qualifications:

  • Bachelor’s Degree in Business Administration, Project Management, Health Administration or healthcare related field.

 

  • Minimum of five (5) years of managed care contract negotiations, implementation, and configuration, for both facility and physician contacts. **Equivalent Experience: ten (10) years of experience running an operations function for a hospital working with senior leadership preferably in managed care or revenue cycle to ensure effective and efficient operation of the payer strategies and managed care departments in the execution of complex projects and initiatives.

 

  • Minimum of three (3) years’ experience supervising and managing projects as well as leading staff and cross-functional teams

 

Preferred:

  • Functional experience with Cerner Soarian Financials, Symplr Contract Management, or other Healthcare Financial Services systems.


Mission To create a Moffitt culture of diversity, equity, and inclusion as we strive to contribute to the prevention and cure of cancer. Vision To advance and accelerate a culture of access, equity, and inclusion. Diversity is a priority at Moffitt and is meant "to promote a culture of diversity and inclusion as we contribute to the prevention and cure of cancer." The Enterprise Equity Department focuses its efforts on eliminating those obstacles to an individual’s ability to exist within their personal comfort zone at the cancer center. Everyone is important to meeting this priority. Addressing and responding to diversity and inclusion fosters an environment where mutual respect for diverse cultures, communication styles, languages, customs, beliefs, values, traditions, experiences and other ways in which we identify ourselves, is the expectation.


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