QNS Recruiting

  • Contract and Compliance Manager

    Posted Date 3 weeks ago(10/29/2018 1:56 PM)
    Job ID
    2018-5097
    Company
    Grane Hospice Care - Pittsburgh
    Location
    US-PA-Pittsburgh
    Category
    Legal & Compliance
    Type
    Regular Full-Time
    Education Level
    Bachelor's Degree
    Experience Needed
    More than 5 years
    Salary Info
    Based on experience
  • Overview

    Grane Hospice

     

    Contract and Compliance Manager

     

    Full Time

     

    Pittsburgh, PA (RIDC Park)

     

    Integrated care leader Grane Hospice Care, Inc. is expanding its core interdisciplinary teams, and seeks a Contract and Compliance Manager. This role requires excellent organizational and communication skills, plus an ability to seamlessly analyze contract information for completeness and accuracy. The contract manager will serve as the main point of contact for payor contracts and will work in conjunction with HR and legal departments for ongoing direction and leadership.

    Responsibilities

    Job Functions:

    • Negotiate and execute contracts with insurance companies and vendors
    • Vetting and analyzing contracts for accuracy and completeness
    • Evaluate and develop payment contract rates
    • Develop, analyze and review proposed contracts for maximized care reimbursement and minimal operational costs
    • Identify areas of contract administration improvement
    • Assure compliance with home health and hospice regulations relevant to provider contracting functions
    • Interpret payor contract language, contract details and agreements related to daily operations – credentialing requirements, rate schedules, term notices, timely filing limits, refunds, etc.)

    Knowledge and Abilities:

    • Strong relationship building skills and ability to work collaboratively with other departments
    • Proven knowledge of payors, managed care contracting negotiation, industry reimbursement trends, payor coverage policies and procedures and utilization review
    • Demonstrated ability to work simultaneously on various projects
    • Prior experience with payment methodology pertaining to Medicare and Medicaid and third-party payors
    • Knowledgeable of home health and hospice rules and regulations
    • Policy and procedure creation and implementation
    • Experience with healthcare claims processing

    Qualifications

    Qualifications:

    • Bachelor’s degree in health care administration, business or other related field, OR equivalent required
    • Minimum of 5 years’ experience in health care contracting role
    • High level of professional, personal integrity and ethics
    • Proficient in Microsoft Office and Excel

    ls0606

    Options

    Sorry the Share function is not working properly at this moment. Please refresh the page and try again later.
    Share on your newsfeed

    Connect With Us!

    Not ready to apply? Connect with us for general consideration.