Managed Care/Payor Relations Specialist
LocationNew York, NY
DeptProfessional - Finance
At Memorial Sloan Kettering (MSK), we’re not only changing the way we treat cancer, but also the way the world thinks about it. By working together and pushing forward with innovation and discovery, we’re driving excellence and improving outcomes.
For the 28th year, MSK has been named a top hospital for cancer by U.S. News & World Report. We are proud to be on Becker’s Healthcare list as one of the 150 Great Places to Work in Healthcare in 2018, as well as one of Glassdoor’s Employees’ Choice Best Place to Work for 2018. We’re treating cancer, one patient at a time. Join us and make a difference every day.
Do you want to be an integral part of one of MSK's growing teams? We believe that this is an exciting role for someone who has the right background to be apart of our dynamic team and who wants to apply their skills to support our mission here. Apply to join The Managed Care & Payor Relations Team at MSK as Specialist.
As the Manager Care/Payor Relations Specialist, you will:
- Develop and evaluate payment rates and strategies for Managed care contracting for hospital and physician services.
- Analyze, develop, and revise models to support contract negotiations. Help develop strategies for maximization of managed care reimbursement.
- Assist in managed care contract language review for existing and new managed care contracts.
- Manage payor contracts in the nThrive Contract Modeling Software. Runs alternate contract models to determine current contract performance vs proposed contract structure and rates.
- Support MSK’s participation in the National Center of Excellence and Bone Marrow Transplant Programs by assisting in rate development and contract negotiations.
- Help prepare the annual clinical and administrative data submission to support initial and continued participation.
- Research and respond to inquiries from internal departments regarding contract terms.
- Interact with managed care companies’ contracting representatives.
- Work closely with billing management in the audit of hospital and physician payments to ensure payor compliance with contract payment methodologies.
- Assist with statistical and financial models and analysis for special financial projects prepared for internal and external review.
- Perform payor-specific reporting and analysis of healthcare industry trends including the impact of government regulations.
- Perform analyses of hospital resource utilization and development of cost accounting methodologies and reports; case mix DRG data to develop and improve management techniques and strategies.
- Assist the Director in the completion of assignments and filings related to the preparation of presentations, reimbursement reports, appeals, and surveys including the Institutional Cost Report.
- A Bachelor’s Degree and a minimum of 4 years’ experience with managed care contracting and rate analysis; or a Master’s degree and a minimum of 2 years of the same experience.
- Detailed focus and managed care experience, specifically in the areas of financial analysis, payment methodologies, contract language and negotiations.
- Knowledge of different payment structures such as FFS, capitation, bundled payments, and shared savings.
- Experience with nThrive/MedAssets contract modeling software preferred.
- SQL knowledge would be helpful but not required.
- Advanced knowledge of Microsoft office products.
- Excellent oral and written communication skills.
- Demonstrated aptitude for analytical thinking.
Application Hiring Process
New York, NY
At MSK, we are committed to providing exceptional patient care that is as convenient as possible. Each of our facilities serves a purpose and is strategically built to support a larger community, including our employees.