Previous Job
Previous
Portfolio Manager
Ref No.: 18-15749
Location: Franklin, Tennessee
Position Type:Contract
Experience Level: 5 Years
PURPOSE AND SCOPE:
Supports FMCNA's mission, vision, core values and customer service philosophy. Adheres to the FMCNA Compliance Program, including following all regulatory and FVC policy requirements. Responsible for Fresenius Vascular Care managed care portfolio performance for assigned territory. Work with Management on implementation of contracting strategy for the organization. Independently negotiate contract language and rates for minor payers or major payers when the scope of the negotiation is limited. Negotiate major payor agreements with Manager or Director support. Monitor contract performance versus expected, and recommend any action needed.

The nature of the responsibilities requires the Managed Care Portfolio Manager to understand the complex and varying relationships with various entities and persons within FVC to determine and plan for appropriate access to highly sensitive, confidential information; and systematically plan and execute medium and long range activities to proactively address changing needs; and respond to extremely urgent, mission-critical projects.

PRINCIPAL DUTIES AND RESPONSIBILITIES:
Developing professional expertise; applies company policies and procedures to resolve a variety of issues.
  • Normally receives general work instructions on routine work, detailed instructions on new projects or assignments. Work is reviewed for soundness.
  • Works on problems of moderate scope where analysis of situation or data requires a review of a variety of factors. Exercises judgment within defined procedures and practices to determine appropriate action.
  • Builds productive working relationships.
  • May provide assistance to junior level staff with general tasks that require a better understanding of functions, as directed by immediate supervisor.
  • May refer to senior level staff for assistance with higher level problems that may arise.
  • Escalates issues to supervisor/manager for resolution, as deemed necessary.
  • Review and comply with the Code of Business Conduct and all applicable company policies and procedures, local, state and federal laws and regulations.
  • Assist with various projects as assigned by direct supervisor.
  • Assist in the development and implementation of Fresenius Vascular Care's strategies and objectives related to managed care contracting with Managed Care Organizations within assigned territory.
  • Responsible for rate and language negotiation of minor payer agreements for all sites with assigned territory. Negotiate rate and language of major payer agreements with Manager and/or Director support. Assist with the development of negotiation strategy for major payers. Negotiate rate and language of major payer agreements independently when the scope of the negotiation is limited.
  • Understand and identify current risks and sources of exposure to FVC centers within assigned territory.
  • Perform various financial analyses to assist with contract proposals including: analysis of Standard Carrier claims data obtained through the Financial Datamart, analysis of medication utilization for global contracts and analysis of rate structure conversion.
  • Maintain current detailed working knowledge of all payor contracts within assigned territory and manage FVC relationship with such payers.
  • Implement, based on Management feedback and information supplied by other FVC entities, managed care contracting policies and procedures to maximize performance in managed care relationships.
  • Provide management with accurate and current managed care market intelligence by maintaining a working understanding of local/regional/national trends, conducting competitive market assessments, staying abreast of changes and impact of regulatory environment, staying abreast of changes and impact of payor initiatives including responses to new products entering the marketplace and provide other information to support division reporting initiatives. Draw conclusions and recommend any action needed based on analysis of industry trends.
  • Support communication of FVC managed care initiatives and results to appropriate audiences. Attend routine and ad hoc meetings representing the department and its managed care initiatives, as needed.
  • Provide education on new agreements as they affect stakeholders via written communications or presentations as needed. Anticipate and address center staff and management needs for information resulting from new or modified agreements.
  • Develop and maintain cooperative internal working relationships with all parts of the FVC organization to effectively evaluate and assess overall impact of contracting initiatives. Serve as FVC Contracting point person for assigned territory.
  • Proactively work with Managed Care Analytics to report and refine reporting of contract performance, analysis and modeling tools.
  • Work closely with Revenue Cycle on operational issues that become contract issues. This includes participation in payor Joint Operating Committee (JOC) meetings.
  • Other duties as assigned.
Additional responsibilities may include focus on one or more departments or locations. See applicable addendum for department or location specific functions.

PHYSICAL DEMANDS AND WORKING CONDITIONS:
The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Day to day work includes desk and personal computer work and interaction with internal and external customers.

EDUCATION:
  • Bachelor's Degree required
  • Master's degree preferred (MBA or MHA preferred).
EXPERIENCE AND REQUIRED SKILLS:
  • 2 – 5 years' related experience; or an advanced degree without experience; or equivalent directly related work experience.
  • Minimum of 2 years' experience as a contract negotiator with a large provider or 5 years small provider or payor experience as a contract negotiator. Prefer experience with a multi-entity organization and/or a large physician multi-specialty group.
  • Must be proficient with standard desktop office applications including Microsoft Office software applications.
  • Must have excellent and effective verbal and written communication skills to communicate with providers and office staff.
  • Must have excellent project management skills. Ability to independently exercise good time management, priority setting, keeping multiple projects on track simultaneously, good organizational skills.
  • Adaptable to change.
EO/AA Employer: Minorities/Females/Veterans/Disability/Sexual Orientation/Gender Identity