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UnityPoint Health Contract Specialist-Managed Care in West Des Moines, Iowa

Works directly with Senior Leaders to facilitate contract negotiations and supports Contract Managers and Director in managing third-party payor contracts. Responsible for managing and tracking provider/payor contractual and payment issues. Responsible for maintaining the SharePoint database for third-party payor contracts for all UnityPoint Health providers.

Contract Implementation

  • Evaluates and negotiates third-party payor contractual amendments for UnityPoint Health providers, which affects business operations substantially and has a significant impact on reimbursement for UPH.

  • Coordinate and assist with the administration of contracts assigned.

  • Acts as a subject matter expert, advising senior leaders when to facilitate negotiation of third-party payor contracts and associated amendments for UnityPoint Health providers, as assigned.

  • Collaborates with Law Department and Revenue Cycle to ensure contracts meet system requirements.

  • Understands the financial impact of contract reimbursement.

  • Monitors contract completion, extension, and renewal appropriate.

  • Provides contract-related issue resolution, both internally and externally.

  • Ensures contractual language is interpreted correctly by all parties.

  • Coordinates with Contract Manager on complex negotiations and drafts all contract documents.

  • Works and meets with stakeholders to resolve concerns.

  • Researches and recommends solutions for issues related to contracts.

  • Responsible for updates, maintenance, and amendments to reflect changes in contract offerings and contract extensions.

  • Facilitates audits as they pertain to assigned contracts.

  • Develops and maintain contract tracking logs.

  • Develops ad hoc reports as requested or assigned.

  • Assists with special projects, as requested by Contract Managers and Director, Payor Contracting.

Basic UPH Performance Criteria

  • Demonstrates the UnityPoint Health Values and Standards of Behaviors as well as adheres to policies and procedures and safety guidelines.

  • Demonstrates ability to meet business needs of department with regular, reliable attendance.

  • Employee maintains current licenses and/or certifications required for the position.

  • Practices and reflects knowledge of HIPAA, TJC, DNV, OSHA and other federal/state regulatory agencies guiding healthcare.

  • Completes all annual education and competency requirements within the calendar year.

  • Is knowledgeable of hospital and department compliance requirements for federally funded healthcare programs (e.g. Medicare and Medicaid) regarding fraud, waste and abuse. Brings any questions or concerns regarding compliance to the immediate attention of hospital administrative staff. Takes appropriate action on concerns reported by department staff related to compliance.

Education:

  • High School Diploma/GED

  • Bachelor’s degree in accounting or healthcare related field preferred

Experience:

  • Two (2) years of healthcare management or equivalent related experience.

  • Previous experience with third-party payors

License(s)/Certification(s):

  • Valid driver’s license when driving any vehicle for work-related reasons.

Knowledge/Skills/Abilities:

  • Excellent written and verbal communication skills

  • Work as a team member, creating and maintaining effective working relationships with internal and external customers.

  • Ability to understand and apply guidelines, policies and procedures

  • Ability to effectively utilize Microsoft Office programs to complete work (Word, Excel)

Requisition ID: 2021-96471

Street: 1776 West Lakes Pkwy

Name: 9010 Administration

Name: Managed Care

FTE (Numeric Only; Ex. 0.01): 1.0

FLSA Status: Exempt

Scheduled Hours/Shift: Fulltime Days

External Company URL: http://www.unitypoint.org

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