Overview:
Company Overview
Youth Villages has been a national leader in the adoption and implementation of research-based treatment philosophies in the field of children's mental and behavioral health. Our commitment to helping troubled children and their families find success spans 30 years and includes a comprehensive array of programs and services.
If you are looking for a positive career move where you are meeting the challenges of life and striving to make a positive difference, then Youth Villages is the place for you. We are looking for people with a strong sense of purpose and focus to continually build confidence in yourself and our organization.
Responsibilities:
Position Overview
Assists the Contract Manager in the consistent management of all Medicaid and managed care payor contracts. This includes involvement in the negotiation of contracts; preparing contract modifications; analyzing procurement policies and procedures; analyzing proposed costs and prices; and preparing required contract file documentation. This requires close collaboration with various departments, including compliance, legal, clinical/medical operations, business development, sales/marketing, finance, and placement services
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.
- Process initial and recurring applications for facilities/offices, physicians, and healthcare providers with Medicaid and managed care funding sources.
- Tracks and monitors contracts throughout their lifecycle from inception to execution and post-implementation; facilitates the routing, approval, and execution of Medicaid and managed care contracts to present for review.
- Coordinates with sales, compliance, legal, and other internal departments to ensure consistent communication of issues related to each client/payor contract and reports specific details as requested or necessary to monitor contract performance.
- Builds, maintains, and enhances relationships with internal and external Medicaid and managed care stakeholders in coordination with the departments goals and objectives.
- Ensures that Medicaid and managed care contracts are properly organized and tracked through the departments management tools and organizations contract database.
- Ensure that facility Doctors and Nurse Practitioners are properly enrolled and maintained as Ordering Referring, and Prescribing providers with each applicable state Medicaid.
- Ensure that each appliable state Medicaid web portals and associated website sites for billing, eligibility, authorizations, and utilization management are properly enrolled and maintained as well as ensuring key staff from finance, placement, and utilization management have security access to such portals.
- Performs appropriate research to support proposal and contract development
- Assures accuracy and appropriateness of contract language and attachments.
- Interfaces with payors where needed to manage relationships and meet department goals and objectives
- Shares knowledge gained with other staff members and works as a team member. Will be the Medicaid and managed care subject matter expert and act as a resource for all internal staff.
- Manages both existing and future contracts between our current facilities/offices/services and Medicaid and managed care payors. Maintain an up-to-date list of active contracts including the initial date of execution, renewals/renegotiation dates, next renewal/renegotiation date, and utilization rate.
- Prepare a comparison reimbursement rate report by service line by contract by location/office. Include in this report a comparison against competitor rates and payors published reimbursement schedules.
- Assist contract manager with resolving contractual issues.
Can work from Jackson, Dyersburg, Paris, or Memphis, TN.
Qualifications:
A High School Diploma or Associate of Applied Science in Health Care Management is required.
Two years of experience in Medicaid and managed care contracting including credentialing and re-credentialing applications for practitioners and facilities.
Familiarity with insurance billing, coding, and terminology.
Proficient and demonstrated knowledge with Medicaid and managed care contracts.
Additional Benefits
Medical, Dental, Prescription Drug Coverage and Vision
401(K)
2 weeks paid vacation
12 paid sick days per year
11 paid holidays
Paid Parental Leave
Mileage & Cell Phone Reimbursement (when applicable)
EOE