The Director of Managed Care Contracting is responsible for the overall development and implementation of payer partnerships and payer network strategy for the company’s managed care program.
This position enhances the company’s managed care program by (1) analyzing contract opportunities to increase and maintain market share, (2) developing payer contracting strategies, execution and key metrics, to include service and operation for different relationships to support payer-financial growth objectives, and (3) negotiating contracts with managed care companies and health plans, including HMOs, PPOs, and other products.
Our Director provides leadership to maintain effective payer partnerships through maintenance of relationships with internal and external sources involved in the contracting process; participation in the development of contract language and negotiation strategy in-depth financial analyses of contract performance and makes recommendations as to the desirability of canceling, renegotiations or extending contracts.
In this role, the Director of Managed Care Contracting also serves as a liaison with the Revenue Cycle department and other internal staff on implementation of contracts and compliance to contract terms to ensure providers are receiving appropriate reimbursement and that other contractual requirements are met.
Key Job Elements:
1. Responsible for direct negotiation of managed care contracts to achieve strategic contracting goals.
2. Responsible for overseeing operations that develop and maintain positive relationships and financially viable contracts with payers and ongoing analysis of existing contracts for compliance and performance review as well as analysis for budgeting revenues, long-range planning.
3. Serve as Liaison with the Revenue Cycle and other operational departments regarding ongoing contract compliance to support key business functions.
4. Assist with development of tools and procedures (for ex: summary grid information on contract terms and/or fiscal summaries, payment reports, timely filing deadlines, etc.) for use by various operational departments, in particular to manage and provide oversight of other contracting staff,
5. Research and investigate related laws or regulations for contracts, health insurance, coverage and related topics.
KNOWLEDGE / EXPERIENCE:
• Bachelor’s degree required, Graduate Degree in Healthcare Administration preferred not req’d
• Minimum of five years in healthcare payor contracting and reimbursement, either on the payor side or within a hospital or diagnostic laboratory setting.
• Strong and direct payor negotiating experience required. Required – highly proficient in Microsoft Excel, Word and Access including import/export functions. Required – strong written and verbal communication skills
• Minimum of 3 years of contract management experience in the health industry.
• Knowledge of and experience with CPT-4 and ICD-9 and HCPC billing, coding and posting charges in medical billing software.
• Knowledge of insurance guidelines including HMO/PPO, Medicare, Medicaid, and other payer requirements and systems.
• Knowledge of insurance plan benefits and terminology.
• Knowledge of and experience with contract payer policies and procedures.
• Knowledge of HIPPA compliance.
• Proficient in Microsoft Office Suite applications
Great benefits. Apply for this great position as a director of managed care contracting today!
We are an Equal Employment Opportunity employer committed to excellence, diversity and inclusion.
Additional Skills
For immediate consideration please e-mail your word formatted resume to Darlene Vergel De Dios at dvdedios@appleone.com