Business Administrative Associate - Provider Contract Specialist, Managed Care

at University of Illinois Hospital & Health Sciences System (UI HEALTH)
Location Chicago, IL
Date Posted November 5, 2017
Category Provider Relations
Job Type Full-time


Business Administrative Associate- Provider Contract Specialist, Managed Care
The University of Illinois Hospital & Health Sciences System (UI HEALTH) is seeking an experience Provider Contract Specialist to perform in-depth financial modeling, analysis and interpretation of contract profitability.

This position serves as an internal liaison between College of Medicine and Hospital. Evaluates and creates financial analysis of contracts and contract profitability, audits and generates reports and executes appropriate action. Performs provider-level financial analysis and develops physician scorecards. Maintains provider and facility contract information for new updates and renewals. Develops, implements and maintains policy and procedures to ensure compliance.

Essential Responsibilities:

  • Extrapolate raw hospital/physician claims data, model the data and prepare and present analysis to senior administrators.
  • Regularly monitor and model utilization data to include but not be limited to the following points of service and service categories: inpatient, outpatient, emergency services, durable medical equipment, primary care services, specialty professional services, high cost drugs, high cost implants, ancillary services.
  • Negotiates one time Letters Agreements and IPA Agreements.
  • Manages renewal activity for existing and new IPA Agreements, including the monitoring of expiration dates and negotiation of rates of reimbursement.
  • Maintains provider and facility databases and contract information for new and renewal agreements, creates and evaluates financial analysis of contracts and contract profitability.
  • Regularly monitor utilization for identification of increased improvement in cost efficiency, percent of charge reimbursement versus fee for service, charge master protection, etc.
  • Assist Director with budget forecasting by completing individual parameters analysis on projected future spend of each contracted provider. Prepare financial impact conclusions on how new rates might affect the organization.
  • Generate reports and provide financial analysis of revenue per department per physician (Physician Scorecard).
  • Directs, coordinates and supervises all activities associate with Internal Provider relations, for assigned respective departments.
  • Meet monthly with Directors of Physician Practice to present Physician Scorecard and lead improvement discussions.
  • Serves as provider liaison to College, Hospital and external payer representatives and supports resolution of escalated incidents through investigation and analysis.
  • Conducts contract negotiations with health insurance plans, outside physician referral sources and external providers.
  • Develops, implements and maintains policy and procedures to ensure compliance, prepares presentations and training, participates in the development of new system implementation, and identifies procedural and system inadequacies, and makes revisions, updates and adjustments where appropriate
  • Other duties as assigned.

Requirements include:
1. Bachelor's degree in business administration, management or a field related to the position.
2. Two years of professional level accounting, managerial and/or business experience, one year of which was at an administrative level.
3. Demonstrated experience with financial analysis of Managed Care contracts and Managed Care contract profitability, including preparing financial analysis models for medical claims reimbursement and creating medical utilization data models required.
4. Demonstrated experience with Managed Care contract negotiations with health insurance plans and Medical clinics required.

Personal attributes required for job:
1. Knowledge of management principle, practices, methods, and techniques.
2. Supervisory and administrative abilities.
3. Decision making ability.
4. Ability to work effectively with the staff and public.

Preferred Qualifications:
1. Proficient in all Microsoft office programs (Excel, Word, Powerpoint, etc.)
2. Strong Analytic Skills.
3. Managed Care related experience.
4. Customer Services related experience.
5. Strong Presentation Skills.
6. Strong ability to multi-task multiple projects.

Salary & Benefits:
UI Health offers competitive benefit packages, including: vacation days, paid holidays, Floating Holidays, State University Retirement System, tuition waiver, tuition discount for dependents, and excellent medical, dental, and vision packages.

To Apply:
For consideration, please submit a complete application and supplemental resume by November 20, 2017. University of Illinois at Chicago is an Equal Opportunity, Affirmative Action Employer. Minorities, women, veterans, and individuals with disabilities are encouraged to apply.The University of Illinois may conduct background checks on all job candidates upon acceptance of a contingent offer. Background checks will be performed in compliance with the Fair Credit Reporting Act.