Title : Payer Contract Manager

Department : Contracting

Type : Full Time

Location : Houston, TX

Job Details :

"You can make a difference in the life of an oncology patient and find your career satisfaction by joining our team of healthcare professionals today."

About Oncology Consultants

Oncology Consultants has been a premier adult medical oncology & hematology practice in Houston, TX, for over 35 years. Our healthcare team is committed to provide state of the art cancer treatment in a caring environment as we continue to expand our oncology services in the metropolitan region.

 

 

About the Position:  

Oncology Consultants is looking for the right person to join our Payer Contracting Teams the Manager of Payer Contracting. Foresight to be a self-starter and enhance our national and local payer contract practice strategies is expected. Oncology Consultants is an oncology patient centric independent practice. We are considered a forward thinking driven leader in the national and local payer and practice community with solutions that follow value-based, physician-driven, and patient-centered agreements. To accomplish this, we are looking for an individual who shares our sense of excellence, is ready to embrace change, demonstrates problem solving and critical thinking skills, and never settles for less than excellence for our patients and practice. The individual must have the confidence to lead but the humility to never stop learning and evolve in a fast-paced payer landscape of change.

Shift Schedule:

  • Mon - Fri: 8am - 5pm

Benefits: Will be available upon becoming Full time

  • Insurances: Life, medical, dental, short term and long-term disability
  • 401K
  • Free parking
  • PTO
  • Holidays 
  • Competitive salary

ESSENTIAL DUTIES AND RESPONSIBILITIES:

  • Collaborate with market colleagues to identify new business opportunities and systematic clinical or operational issues with payer contracts.
  • Build and manage relationships with payers with a focus on education around oncology specific different payment methods, fee schedules and payer policies as a value proposition (as defined by the market’s local asset portfolio and competitive landscape)
  • Resolution of both business and clinical operational issues.
  • Drives increased payer penetration across the continuum of care, as defined by the local market.
  • Oversite and manage department staff and maintain payer resource database, including PMS system payer agreements and fee schedule database.
  • Work closely with the Director of Contracting on the national and local market payer strategies, in collaboration with internal professional colleagues.
  • Owns and manages all aspects of assigned managed care payer relationships in support of the Payer Market Strategy, including (i) identifying demand and scheduling meetings with the relevant payer contacts, (ii) creating tailored presentations/materials, (iii) seeking preparation and attendance support from appropriate colleagues based on the agenda, and (iv) facilitating the meeting.
  • Sponsors (ideally) annual joint meetings with assigned payers to identify and discuss strategies to resolve key clinical and operational issues, including (i) coordinating with the payer to prepare the agenda, (ii) inviting the appropriate Oncology Consultants stakeholders, (iii) preparing the necessary materials in support of the agenda, and (iv) facilitating the meeting.
  • Maintains relationships and resolves clinical and operational issues with payer/provider organizations under a contractual or risk-bearing agreement by acting as liaison with payer contract manager, senior provider relations, or any payer management staff.
  • Analysis on payers new, renewal and ongoing maintenance reimbursement methodology and compliance.
  • Implement new and maintained payer contracts and fee schedules in the practice managed database on an annual and quarterly basis to ensure compliance of payer agreements.
  • Education of core relevant elements of new or renegotiated contracts, including preparation of training materials.
  • Manage and oversite of department Payer Liaisons and staff including key areas of operations under the Knack Health Plan Solution Resolution Database.
  •  Enhance and provide performance of key performance indicators (KPI) quarterly reports regarding Knack Health Plan Resolution Solution database.
  • Update Contracting Department SharePoint with payer-specific activity and provide direction to department staff to perform update.
  • Direct internal staff on projects and task required for the department success.
  • Document critical reporting capabilities for the Contracting Department based on payers evolving data needs, as identified in management and other meetings.
  • Attend local and national conferences, as relevant.
  • Document goals, activities, and accomplishments. Communicates and prepares reports on activity, industry trends, new business opportunities, statistical information/market share and other as required by the Executive Team, and Director of Payer Contracting.
  • Maintain close involvement and active membership with professional industry related organizations locally, state and nationally.​​​​​​​

How You Can Make a Difference

  • Negotiate complex, value-based payer agreements, and participate in the strategic development of payer contracting initiatives.
  • Implement and maintain the contracts, structures and reimbursement methods and rates.
  • Work closely with staff team members and other operation departments to ensure that key provider support processes are well functioning.
  • Participate in business development efforts and initial outreach.

Skills For Success

Demonstrated track record of building strong working relationships across operational leaders and potential payer partners.

  • Bachelor’s degree in Business or Healthcare Administration required.
  • Minimum of 3 to 5 years in progressive roles required.
  • Experience modeling payer contracts.
  • Knowledge of value-based contract methodologies and preferred financial and administrative terms.
  • Experience negotiating quality and efficiency metrics preferred.
  • Ability to think independently and develop new processes/analyses required.
  • Strong organizational skills with the ability to multi-task and execute against multiple competing priorities.
  •  Proficiency in Excel, PowerPoint, and Word required.

This description is intended to describe the essential job functions, the general supplemental functions and the essential requirements for the performance of this job. It is not an exhaustive list of all duties, responsibilities and requirements of a person so classified. Other functions may be assigned and management retains the right to add or change the duties at any time

Oncology Consultants is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Medical Center | Memorial City | Sugar Land | Katy | Willowbrook | Southwest Northwest | West Houston

Apply today. Our short application process takes less than 5 minutes with your phone, tablet or computer.