A

Ann & Robert H. Lurie Children’s Hospital of Chicago

Pediatric healthcare provider and teaching partner

Managed Care Contractor

Contract ManagementConfirmed live in the last 24 hours
Full-timeChicago, IL, USA$99.8k - $164.7kIn-person

About the Job

Requirements

  • A bachelor's degree is required.
  • Transplant experience and familiarity are required.
  • Strong analytical ability is required.
  • High-level communication skills are required.

Responsibilities

  • Negotiate Single Case Agreements for transplants, general and surgical medicine, and hospital ancillary agreements.
  • Assist with or lead transplant contract negotiations, validate profit and loss values by payor, and assist the Transplant Team with Report for Information requirements and requests.
  • Negotiate, manage, and track requests for single case agreements for out-of-state Medicaid and non-contracted HMO payers.
  • Track and evaluate single case agreements and transplant agreements, monitor outcomes and contract performance, and validate accurate and timely billing and reimbursement under agreements.
  • Establish a process for monitoring timelines and contract terms to eliminate retrospective requests for single case agreements with non-contracted payers.
  • Assist the Director of Managed Care Contracting with commercial payers, Marketplace Exchange, and IPA/PHO/CIN groups.
  • Oversee and control factors creating financial loss and liability related to out-of-state Medicaid and non-contracted HMO members seeking access to care.
  • Serve as the primary contact for Lurie Children’s employees regarding out-of-state Medicaid and non-contracted HMO members seeking or receiving care at the facility.
  • Provide education and in-services on the out-of-network process as needed, and validate that accurate and complete information is provided during that process.
  • Serve as the main contact for payor negotiations with out-of-state Medicaid payors, non-contracted HMOs, and Marketplace payors.
  • Develop a database of historical out-of-state Medicaid transplant events and encounters, including states, payor names, credentialing challenges, letters of agreement needed per admission, and payments due compared with payments received.
  • Assist in negotiating contracts for HMO IPA groups and other entities or specialties, including behavioral health, surgical centers, and therapy centers, as requested by leadership.
  • Work with a designated Patient Financial Services representative to maintain ongoing reports for accounts receivable with the IPAs.
  • Work with a designated Patient Financial Services representative to develop a checklist that improves tracking of transplant billing and collection and individual payor contract terms.
  • Collect information related to out-of-state Medicaid and non-contracted HMO cases, including demographics, reimbursement terms, prompt billing and payment timelines, and case- or state-specific problems; prepare summary reports for leadership as needed.
  • Review inpatient reports daily to identify unplanned out-of-state Medicaid patients and determine education needed by divisions or teams regarding the out-of-network process and follow-up.
  • Identify areas needing assistance to ensure out-of-state Medicaid and non-contracted HMO cases are appropriately identified.
  • Identify and investigate out-of-state Medicaid and non-contracted HMO cases.
  • Establish and manage positive working relationships with internal and external partners.
  • Coordinate with Patient Financial Services and transplant billers to evaluate transplant contract profit and loss at the program level.
  • Develop actual-versus-expected reporting to monitor transplant contract performance.
  • Work with Patient Financial Services to identify potential errors and contract-compliance issues in transplant billing under contracts and letters of agreement.
  • Work with Managed Care Operations to analyze and establish targeted reimbursement levels in agreements.
  • Participate in commercial and Medicaid payor meetings and relevant internal meetings, including medical management and denial meetings.
  • Maintain ongoing knowledge of the No Surprises Act, including revisions and amendments.
  • Assist in investigating Financial Council cases for the annual report and track cases for concurrent monitoring against the Financial Council budget.
  • Assist the Case Management team with appeals based on contract terms.
  • Lead and assign work to others, with frequent follow-up.
  • Perform other responsibilities as assigned.

Desired Qualifications

  • A master's degree is preferred.
  • A nursing background is a plus.
  • Knowledge of EPIC is a plus.
  • Five years of healthcare experience in managed care negotiations on the payor or provider side is preferred.

About the Company

Ann & Robert H. Lurie Children’s Hospital of Chicago

Pediatric healthcare provider and teaching partner

Ann & Robert H. Lurie Children’s Hospital of Chicago is a leading pediatric hospital and teaching hospital, providing comprehensive medical care for children across specialties. It operates as the region’s largest pediatric healthcare provider, offering hospital-based care and serving as a teaching and research partner with Northwestern University Feinberg School of Medicine. Its services are delivered through pediatric clinicians and researchers who diagnose, treat, and manage a wide range of childhood conditions, often incorporating education and clinical research into care. The hospital differentiates itself by its size in the region, its strong academic affiliation, and national rankings across all 10 pediatric specialties by U.S. News & World Report. Its goal is to improve child health by delivering high-quality care, advancing medical knowledge through research, and training the next generation of pediatric clinicians.

Company size
5,001-10,000
Company stage
Grant
Total funding
$10M
Headquarters
Chicago, IL
Founded
1900

Recently Posted Jobs

Explore more opportunities at Ann & Robert H. Lurie Children’s Hospital of Chicago

See more jobs