Job Description

JOB TITLE: Manager, Payer Relations and Contracting, University Physicians

SUPERSEDES: 08/23

FLSA: Exempt

JOB CODE: 0180

ISSUED: 08/2023

REVISED: 12/2023

BASIC FUNCTION AND RESPONSIBILITY

The Manager, Payer Relations and Contracting, University Physicians manages all the employees on the University Physicians Contracting and Provider enrollment team and the areas of Provider Enrollment, Reimbursement variances, and Contract auditing. In addition to the management duties, this position also performs FMV evaluations and compiles all the University Physicians data for business proformas internally and externally. The position is key to ensuring that the department performs at a high level and meets deadlines.

ESSENTIAL FUNCTIONS

Manage staff for all different areas: contract variances/denials, provider enrollment, contract auditing, and decision support leading department strategic initiatives and employee management.

Evaluate cost and benchmarking data for physician wages, benefits, etc. to derive negotiated rates to be used in the contract for Fair Market Value purposes. Provide this and any other needed information for Professional Service Agreements.

Perform Business Proformas for new services based on a cumulation of analysis on expenses, cost to provide the care, and reimbursement from various payers.

Complete University Physicians Financial Analysis as requested for expenses related to new services, locations, or contracts. Also completes University Physicians Financial Analysis as requested and communicates clearly and professionally with the department administrators, chairs, and other associates the results.

Manage Department, Payor, and Enrollment issues and follow up as needed. Report any concerns to University Physicians leadership.

Assist with contract analysis for the managed care payor fee schedule and policy changes. As well as to monitor the impact of regulatory changes from the governmental payors.

Manage the development, coordination, and maintenance of daily staffing schedules to ensure the appropriate level of coverage and continuity of care.

Monitor and oversee time and attendance in alignment with MU Health Care policies and practices, ensuring accuracy of records and timely approval for payroll purposes.

May complete unit/department specific duties as outlined in department documents.

KNOWLEDGE, SKILLS AND ABILITIES

Proficiency in various computer operating systems.

Knowledge of various types of physician compensation.

Excellent leadership skills and experience in managing staff in multiple areas.

Ability to effectively organize and prioritize work.

Ability to collaborate cross-functionally throughout the .

SUPERVISION RECEIVED

Supervision is received from the Senior Director, Payer Operations or designee.

SUPERVISION EXERCISED

Supervision is exercised over contracting/clinician staff.

REQUIRED QUALIFICATIONS

Bachelor's degree.

Five (5) years of relevant experience.

PREFERRED QUALIFICATIONS

Additional license/certification requirements as determined by the hiring department.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met with or without reasonable accommodation. The performance of these physical demands is an essential function of the job. The employee may be required ambulate, remain in a stationary position and position self to reach and/or move objects above the shoulders and below the knees. The employee may be required to move objects up to 10 lbs.

PERFORMANCE EXPECTATIONS

This position is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job; however, completion of these duties is a measure of successful performance. Employees of this job classification are subject to performance reviews. Basic function, responsibilities and characteristics duties may change at any time with or without notice.

SAFETY SENSITIVE STATUS

This position is considered safety sensitive.

This document is a general description of typical job duties, responsibilities and qualifications of employees holding the associated job title. Additional duties, specific qualifications and work emphasis may vary between individual positions.