ESSENTIAL DUTIES AND RESPONSIBILITIES
- Reviews, analyzes, and redlines third-party regional and national managed care contract documents from initial submission through execution and implementation, including contract comparisons and general compensation analyses ensuring contract and other legal documents reflect managed care strategic goals.
- Work closely with other departments (Medical Analytics/Reimbursement Systems/Revenue Management and operations) to ensure contractual reimbursement and operational terms are consistent with company’s policies and procedures.
- Review agreement requests from managed care staff and management clients and determine which agreements are suitable to address clients’ business goals, including Non-Disclosure/Confidentiality Agreements, Business Associate Agreements, Letters of Agreements, supplier agreements, and settlement agreements.
- Assists field managed care sales staff by interpreting existing contract language.
- Performs research of managed care legal issues, including state and federal regulations related to Medicare, Medicaid, HMOs, PPOs, and maintains working knowledge of basic healthcare regulatory requirements.
- Researches State and federal laws and regulations applicable to contract interpretation issues and company processes.
- Oversees review of, as requested, contract documents or work product produced by Contracts Analysts/Contract Specialists.
- Drafts correspondence and provides legal advice relative to contract disputes.
- Oversees special projects as requested by company internal clients.
- Performs other duties as required.