Job Description
Job Description
Come join an exciting and innovative company that puts the “care” back in healthcare!
At KabaFusion, our patients come from all walks of life and so do we. We hire GREAT people, period! Our culture celebrates and supports the differences that make us unique. Here, it doesn’t matter what your role is, your hard work and dedication is not only recognized but celebrated. Join us and find out why this is the place to excel and do your best work.
About Us:
What started as a single pharmacy in 2010 has grown into KabaFusion becoming the largest privately held home infusion company in the country. We have a national network of pharmacies and nursing offices strategically placed to service 40+ states. Couple that with over 30 years of combined experience and it’s no wonder why KabaFusion is the industry leader in home infusion.
JOB SUMMARY:
Responsible for oversight of the managed care contracts through implementation of systems assuring contract compliance, contract data management, and business development as it relates to health plans/payors. Overall field support will include but it not limited to negotiations, contract interpretations/clarification, case management, education and resources. Understanding claims and intervention when required as the liaison between KabaFusion and health plan/payors. Understanding of current law and regulations and as may be directed by AVP of managed care.
MAJOR DUTIES AND RESPONSIBILITIES:
1. Contract negotiation/renegotiation with health plans, medical groups, IPAs or other managed care payor sources.
2. Ability to establish and maintain professional business relationships with health plans contract managers.
3. Annual rate negotiations
4. Knowledge/Understanding of Division of Financial Responsibility of payors
5. Knowledge/Understanding of varies payor product lines
6. Knowledge of and routine review of contract language
7. Assure Pharmacies remain fully credentialed with all payors to include management of documents required for credentialing process
8. Provide assessment and recommendations for contractual operation of managed care patients
9. Provide training support/resources to the field related to managing/analyzing costs
10. Knowledge of high cost medications /supplies/DME and education/review of pharmacy costs to identify exclusions and guidance to AR on collecting
11. Implement cost reduction measures for the provision of ancillary services of managed care include analysis, recommendations, etc.
12. Assist with creation and implementation of managed care policy and procedures
13. Update/maintain managed care manuals cost analysis and contracts
14. Ensure all contracts meet company standards and are fully executed
15. Other duties as assigned.
SKILLS AND ABILITIES:
- Knowledge of managed care contracting billing and negotiations skills a must
- Strong oral and written communication skills
- Strong problem solving skills
- Exceptional computer skills specially in Microsoft Word, Excel and Outlook
- Strong interpersonal skills to interface effectively with all levels of personnel
- Ability to maintain confidential company information
- Attention to detail
- Ability to self-direct work and effectively multi-task
EDUCATION AND/OR EXPERIENCE:
- Must possess at a minimum, Bachelor’s degree in Business or related experience
- Minimum of 7 years of experience in health care industry, infusion experience a plus
- At least 3 years managed care contracting, billing and negotiations skills required
What we offer:
- Competitive compensation
- Benefits start on your 1st day of employment
- 401k w 4% match – no waiting or vesting period
- PTO / Floating Holidays / Paid Holidays
- Company paid life insurance, short term disability
- Employee Assistance programs to help with mental health / wellness
- Learning & Development Programs
- Perks… includes discounts on travel, cell phone, clothing and more…
- Generous employee referral program
To learn more about KabaFusion, please visit our careers page: https://www.kabafusion.com/careers/
Join us and find out why this is the place to excel and do your best work.