Manager - Market Access Contracts

Manager - Market Access Contracts

Position Summary

This position is responsible for reaching out to providers (Market Access plans, Medicare, and Medicaid) to develop a provider network, evaluate, analyze, negotiate and implement new contracts and monitor existing contracts in terms of contract rates within established contract parameters and timeframes. 

Job Responsibilities

• Identifies appropriate contracting and re-contracting opportunities.  For new relationships, performs business and market analysis to determine viability of contracting.  
• Collaborates with Market Access organizations to gain a thorough understanding of payor specific requirements, reimbursement logic and limitations.  
• Manages all aspects of the contract lifecycle.  Collaborates to assemble and gain an understanding of payor specific data, operations issues and business review.  
• Responsible for managing the partnerships with Multiplan's, TPA's and Marketplace plans
• Faciliates Single Case Agreements when applicable, and proactively communicates internally.
• Communicates contract changes internally, maintains appropriate documentation, reviews contract performance with appropriate metrics, and makes appropriate recommendations.
• Facilitates problem solving of escalated contractual and operational issues through collaboration with Market Access organizations and internal stakeholders.  
• Coordinates with internal team to ensure contractual terms, including payor-specific requirements, reimbursement logic are understood.  
• Serves as expert on all terms of the payor contract and as a communication link between providers and Caris.  
• Stays abreast of changing healthcare landscape to maintain an awareness of competitor services and reimbursement models, as well as opportunities for improvement in the financial and operational components of Market Access contracts.  

Required Qualifications

• Bachelor’s degree 
• 3-5 years experience in network management, revenue cycle management, contracting and/or relations in a healthcare field.
• Strong understanding of healthcare delivery systems, specifically commercial and government-sponsored programs such as Medicaid and Medicare. 
• Strong understanding of the Market Access environment, including but not limited to Market Access policies and procedures, reimbursement, billing principles and practice management/medical office procedures. 
• Ability to work both independently and in a dynamic team environment with rapidly changing priorities and demands.  Excellent written and oral (presentation) skills.
• In-depth knowledge of payor contracting and negotiation
• Working knowledge of privileging, credentialing, provider enrollment and Market Access contracting requirements, practices, and industry standards.
• Ability to be a liaison between Market Access, Revenue Cycle and Operations.
• Ability to work collaboratively with Revenue Cycle Management (RCM) to address underpayments and incorporate lessons learned from vendors and colleagues into contract negotiation strategies. 
• Self-starter collaborative mindset with the ability to work effectively and efficiently in a fast-paced dynamic environment and adaptability to balance changing and competing priorities. 
• Ability to effectively communicate contracting concepts to non-contract audiences.
• Exceptional communication skills and strong team collaboration abilities.
• Strong knowledge of Microsoft Office Suite, specifically Access, Word, Excel, Outlook, Accounting Software, and general working knowledge of Internet for business use. Demonstrated ability to learn new software.

Preferred Qualifications

• JD or other related graduate-level degree is a plus
• Strong interpersonal and partnership skills including negotiation.
• High degree of accuracy and attention to detail.
• Discretion in dealing with sensitive confidential information.
• Ability to carry out duties with limited supervision.
• Knowledge of regulatory standards and compliance requirements.
• Effective organizational and time management skills.
• Previous contract drafting and negotiation experience or related experience in the pharmaceutical, biotech, or related industry is preferred

Training

• All job specific, safety, and compliance training are assigned based on the job functions associated with this employee.

Physical Demands

• Must possess ability to sit, stand, and/or work at a computer for long periods of time.
• Ability to work extended hours during implementations and on-call rotations. 

• Must possess ability to perform repetitive motion.
• Majority of work is performed in a desk/cubicle environment.

Other

• Travel Required – typically 2x quarterly

Conditions of Employment:  Individual must successfully complete pre-employment process, which includes criminal background check, drug screening, credit check ( applicable for certain positions) and reference verification.

This job description reflects management’s assignment of essential functions. Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.

Caris Life Sciences is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability.