To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.
The Contract Coordinator for the Yale New Haven Health System, Managed Care Division is responsible for the, review, implementation and problem resolution for managed care contracts on behalf of System affiliates (Yale New Haven Hospital, Bridgeport Hospital, and other affiliates).
- 1. Negotiate managed care contracts for affiliates. Negotiate single case agreements for non-standard services or non-contracted plans. Communicate affiliate and single case agreement information to System Business Office to assure appropriate billing.
- 2. Responsible for the negotiation and maintenance of the current managed care transplant agreement. Negotiate single case agreement as needed. Establish a strong working relationship with the Yale Medical Group and communicate information on global transplant agreements and arrangement as needed.
- 3. Work closely with provider units to ensure the delivery of cost-effective quality services through contacts. Ensure appropriate financial review of payer contracts and manage feedback to meet contract completion time frames. Analyze payer proposals to determine impact on overall hospital budget.
- 4. Maintain accurate contract inventory and communicate any discrepancies between contractual terms and actual payments to internal departments. (Admitting, Patient Accounts, System Business Office, and Reimbursement). Communicate initiatives and managed care policy updates and changes. Develop documentation to educate internal departments as needed.
- 5. Assist Managed Care Division in communicating and loading payer agreements into System's Billing System (SDK) and/or assist with obtaining missing information from payers to adequately set up agreements in the billing system.
- 6. Research and resolve managed care issues on contractual terms, reimbursement and plan designs. Respond to internal departments about managed care contracts and represent Managed Care Contracting Department at assigned managed care payer meetings and internal Contract Issues meetings
Bachelor's degree required.
At least 3 years experience in managed care contracting. Knowledge of provider reimbursement and coding; contracting experience and familiarity with capitation/risk arrangements and financial models. Proven analytical skills; proficiency with spreadsheet/database programs; strong interpersonal and communicative skills. At least two to three years of managed care experience. Detailed knowledge of provider reimbursement and coding.
Excellent personal computer skills and analytical abilities. Strong interpersonal and communication skills for interacting with internal and external customers.