Managed Care and Physician Relations Analyst

Education:
Bachelor of Science, Business, Health Administration or related work area experience

Licensures/Certifications:
Not Applicable

Experience:
Three years of local managed care experience, insurance, insurance marketing, and/or clinical services.

Skills:
* Extensive knowledge of managed care/insurance company practices and contracting
* Skill in oral and written communication
* Skill in data analysis and interpretation
* Skill in negotiation tactics
* Strong skill in using computers and personal productivity applications

Principal Duties and Responsibilities:
* Evaluates proposed contractual relationships as requested by Director and provides analysis of contractual, operational and pricing issues. Assists in the negotiations, coordination of internal resources and data gathering to finalize contract.
* Coordinates the implementation of new GBMC contracts, ensuring that appropriate departments have information to administer contract. Also, identifies and facilitates in-service for existing payers who have updates or new information to share. Communicates payer contract updates and changes to policies and procedures.
* Review, negotiate and monitor risk sharing payment models, contracting and credentialing for GBMC and GBHA.
* . Facilitates all aspects of RFP process by functioning as project leader.
* Assist and facilitate payer and GBHA/GBMC collaboration and alignment.
* Develops and conducts surveys related to new technology, benefit coverage, and pricing issues. Assists in providing market intelligence on payer policies and strategies for various clinical and professional services.

* Understand delegated credentialing contracts and requirements of the various payers and the National Committee for Quality Assurance (NCQA). Includes data management and routine reporting to payers.
* Coordinates credentialing efforts with Medical Staff Office and physician practices assuring that all payer and NCQA requirements are met. Credentialing includes both provider and facility credentialing and re-credentialing with over 30 payers. Includes payer site audits, office site audits and data management to support audits.
* Investigates physician and payer billing and/or contractual service problems for both GBMC providers, facility, and payers.
* Assists in communicating new products and services to the physician and payer market.
* Builds further relationships with existing medical staff and is responsive to their needs in a timely and professional manner.
* Manages and monitors the contact software for physician data entry, issue resolution, reporting, and follow up in Marketware and Echo Builds further relationships with existing medical staff and is responsive to their needs in a timely and professional manner.
* Manage and monitor contract management system MPV for key payers. Manages and monitors the contact software for physician data entry, issue resolution, reporting, and follow up in Marketware and Echo
* Facilitate, maintain, produce and submit data to payers for HEDIS, quality measures, credentialing, pay for performance to fulfill current and future risk share agreements.

Pay Range

Final salary offer will be based on the candidate's qualifications, education, experience and alignment with our organizational needs.

COVID-19 Vaccination

All applicants must be fully vaccinated against Covid-19 or obtain a GBMC approved medical or religious exemption prior to starting employment at GBMC Healthcare, to include Gilchrist and GBMC Health Partners.

Equal Employment Opportunity

GBMC HealthCare and its affiliates are Equal Opportunity employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.