Kettering Health is a not-for-profit system of 13 medical centers and more than 120 outpatient facilities serving southwest Ohio. We are committed to transforming the health care experience with high-quality care for every stage of life. Our service-oriented mission is in action every day, whether its by providing care in our facilities, training the next generation of health care professionals, or serving others through international outreach.

Responsibilities:

• Lead assigned negotiations (i.e., health, physician and ancillary) and ensure that negotiations result in the unit cost targets.
• Facilitate and support provider set-up and contract configuration to ensure accurate claims adjudication.
• Serve as lead in the development and deployment of contracting initiatives related to organization employed and clinical integration aligned physicians and ancillary entities including managing clinical integration payer contract as needed.
• Participate in financial modeling and analysis, and contract compliance and oversee compliance/ expected reimbursement software.
• Provide leadership in handling negotiation, withing organization strategy guidelines and payer initiatives, including writing documents/agreements, establishing reimbursement methodology and rates of payment.
• Evaluate and monitor providers performance standards and financial performance of contracts.
• Act as a liaison between contracted payers and medical offices on administrative and operational issues.
• Assist with credentialing activities as needed.
• Facilitate the organization of provider operational and strategy workgroups including the coordination of periodic payer operations meetings.
• Coordinate with internal departments and contracted providers to implement and maintain contract compliance and issue resolution.
• Other Managed Care duties needed to complete and execute on contracted documents for organization while maintaining partnership with desired with Payers

Requirements:

• Bachelors degree in business administration, finance, accounting, healthcare or related field required; Masters Degree in Business Administration or Healthcare with emphasis on finance or accounting preferred; equivalent experience will be considered in lieu of education if actively pursuing a business degree.
• Two or more years of experience in managed care negotiation or related role such as contracting or payer analysis.
• Extensive knowledge of hospital and physician reimbursement methodologies, i.e., DRG, Resource Based Relative Value System.
• Two years experience in fee schedule development and utilizing financial models and analysis in negotiations with payers.
• At least an intermediate level of knowledge of health insurance claims processing systems and billing guidelines.
• Experience in performing pro-forma analysis with payer contracting.

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PI143194688