Roles and Responsibilities of a Managed Care Negotiating Team

Roles and Responsibilities of a Managed Care Negotiating Team

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Roles and Responsibilities of a Managed Care Negotiating Team

Businesses including health care facilities while carrying out their activities need to consider suitable ways of negotiating some of the issues that could impact on their services. Developing an effective negotiating team requires the group in charge of the process to include as many parties as possible that shall play different critical roles. Engaging as many parties as possible into the negotiating team provides several merits with the primary one being that the facility stands to negotiate on a number of issues without feeling left out or secluded. Nonetheless, the facility could experience some constraints in negotiating on some aspects if it lacks qualified representatives in various categories. The report highlights some of the parties that would form part of an effective managed care negotiating team, and elaborates on the chief roles and responsibilities of each.

Administration

The administration is an important party to include in the negotiation process thereby calling on the teams to consider incorporating the organizational administrators. Horowitz (2009) writes that the administrators are a vital component of a negotiation process because they may offer guidance on what policies and procedures are required to achieve better outcome at the managed care facility, and because they may give insight on what it requires to overcome the leadership challenges that could affect normal operations. More essentially, administrators need to be part of the negotiating team because they may brief the team on the administrative issues derailing proper progress.

Finance

The finance department is an essential part of any organization, thus making it necessary to include workers from this division in the negotiation process. The group representing the finance division may provide information regarding the group’s financial capabilities when it comes to handling various operations at the managed care facility. Representatives of the finance department may also provide awareness on what the company can do to improve financial operations including supporting the training of employees in the area and installing better technology. Members from the finance division may also benefit the negotiation process because it would give suggestions on how to cut spending in areas that happens to burden the organization yet they are not very essential. Employees from the finance division are also likely to be beneficial during the process because they will sensitize on what methods are necessary to make the issuance of payrolls more effective.

Health Information Systems (Medical Records)

The negotiation process may produce the best results when employees in charge of health information systems or medical records take part in the process. Workers in this area will take charge of explaining why the organization requires an effective system to handle healthcare information and data (Brett, Friedman & Behfar, 2009). The practitioners will inform on the best ways to develop systems that gather, store, control, and transmit a customer’s medical records using electronic methods. Otherwise, the firm may not be in a position to negotiate effectively with regard to handling of patients’ records.

Information Technology

Workers servicing in the IT division are a vital part of the negotiation team because of the information they are likely to offer. The representatives in this area are likely to provide insight on the best way to carry out programming, as well as inform on the software that could improve organizational performance (Brett, Friedman & Behfar, 2009). Engaging IT team in the negotiation process is also likely to be beneficial because of the possibility of gaining insight on how to make the company’s website more effective in terms of marketing the firm or communicating with stakeholders.

Admissions and Registration

The negotiating process may be more effective in terms of its outcomes by including representatives from the admissions and registration unit. The practitioners in this area will give insight on what it takes to achieve better planning, organization, maintenance, and management of the operations and processes of admission and registration into the facility (Horowitz, 2009). More importantly, workers in this area shall give valuable insight on how to plan, implement, administer, and evaluate services and projects impacting the health facility’s operations.

Billing and Collections

Including members from the billing and collections division shall be of great value to the negotiating process. The participants are likely to gain much awareness on what it takes to improve the process of receiving payments paid to patients or customers’ accounts, as well as gain insight on how to identify and manage overdue accounts using better technology and advanced software (Brett, Friedman & Behfar, 2009). Representatives from the billing and collections team may also improve the nature of the negotiation process because the group may understand better what it requires to better interactions with customers either in person or by telephone to inquire reasons for failure to remit payment in time.  

Legal and Compliance

Employees representing the firm in legal matters are equally important during the negotiation process. The service men and women in this category may be of benefit to the negotiation process because they shall inform of what the group needs to do to avoid legal or compliance issues (Mcguigan, 2015). The team may be of great importance to the negotiation process because they may inform on what it takes to overcome legal issues the firm faces, as well as brief the group of some of the repercussions for not complying with rules and regulations set by the state.

Nursing

Including representatives from the nursing fraternity shall be of vital importance to the negotiating process. Representatives in this area are likely to provide insight on the best approaches of taking care of patients regardless of their religious and ethnic backgrounds and affiliations (Simoes, 2014). Further, the negotiation process is likely to yield better results by engaging members of the nursing fraternity because the individuals shall give effective suggestions on how to improve the use of medical history to offer care, as well as on how to administer treatments and medication (Simoes, 2014). More importantly, nurses are likely to suggest ways of advancing diagnostic tests.

Ancillary Department

It would be essential to include members of the ancillary department in the negotiating team of managed care because of the essential roles the members will play. The representatives are likely to provide awareness on the other factors or services that could be essential to patients other than the primary care they receive from physicians (Simoes, 2014). Representatives from the ancillary department may suggest on what needs to happen, or what needs to be purchased to facilitate care to patients within the health care facility or in other settings such as their homes (Simoes, 2014). Nonetheless, the negotiating team may lack adequate insight on what it might take to make ancillary services more effective.

Physicians

Including physicians in the negotiating team is likely to have significant impact on the negotiation process. The negotiation process through the engagement of physicians is likely to become aware of what measures are necessary to improve the facility’s relationship with members of the community (Jonsen & Jameton, 2007). More essentially, incorporating physicians in the process improves the chances of understanding what needs to happen to prevent adverse social effects on patients, and may also provide the opportunity to know how external forces such as the government could help in providing medicine as well as other resources to advance health care services and operations.

Other necessary members

Other than the teams mentioned above, the negotiation process is likely to be more productive by engaging shareholders who are equally important in running of the managed care facility. The shareholders’ primary role would be safeguard their interests by giving suggestions in areas they feel could either affect or benefit their investment in the organization (Simoes, 2014). Failing to include shareholders in the process may be detrimental because the team may choose to embrace conclusions that could not go well with the people who invest in the company. Including shareholders in the negotiating team, therefore, is very essential.

Conclusion

The study elaborates how the negotiating team of managed health care is likely to be production through the engagement of different parties. The report pays particular attention to the roles and responsibilities of various divisions including; the administration, finance, health information systems, IT, admissions and registration, billing and collections, legal and compliance, nursing, ancillary departments, physicians, and shareholders. Incorporating all these parties is likely to result in a successful negotiation process because nearly all aspects will be put into consideration.

References

Brett, J., Friedman, R., & Behfar, K. (2009). How to manage your negotiating team. Harvard

            Business Review, 87(9), 105-109.

Horowitz, R. (2009). Manager’s roundtable negotiating managed care contracts. Laboratory

            Medicine, 27(9), 582-586.

Jonsen, A., & Jameton, A. (2007). Social and political responsibilities of physicians. The Journal

            of Medicine & Philosophy, 2(4), 376-400.

Mcguigan, P. (2015). Negotiation best practices: What a healthcare professional needs to know

            today. The Journal of Medical Practice Management, 30(5), 354-357.

Simoes, E. (2014). Leadership and negotiation skills. Lisbon, ISCTE Business School Press.