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 27th 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 2016, as well as Glassdoor’s annual Employees’ Choice Awards 2017. We’re treating cancer, one patient at a time. Join us and make a difference every day.
The Managed Care & Payor Relations Team at MSK is seeking a Specialist to be an integral part of their growing team.
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.
Excellent oral and written communication skills.
Demonstrated aptitude for analytical thinking.
MSK is an equal opportunity and affirmative action employer committed to diversity and inclusion in all aspects of recruiting and employment. All qualified individuals are encouraged to apply and will receive consideration without regard to race, color, gender, gender identity or expression, sexual orientation, national origin, age, religion, creed, disability, veteran status or any other factor which cannot lawfully be used as a basis for an employment decision.
Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.
As one of the world's premier cancer centers, Memorial Sloan-Kettering Cancer Center is committed to exceptional patient care, leading-edge research, a...nd superb educational programs. The close collaboration between our physicians and scientists is one of our unique strengths, enabling us to provide patients with the best care available today as we work to discover more effective strategies to prevent, control, and ultimately cure cancer in the future. Our education programs train future physicians and scientists, and the knowledge and experience they gain at Memorial Sloan-Kettering has an impact on cancer treatment and the biomedical research agenda around the world.