It's fun to work in a company where people truly BELIEVE in what they're doing!
We're committed to bringing passion and customer focus to the business.
Role:
The Provider Contracts Director is responsible for initial managed care and provider contract negotiations as well as assessing current contract performance data, identification of specific revenue enhancement opportunities and renegotiating contracts to improve financial outcomes. In addition, this role collaborates with the Third Party Administrator (TPA).
Qualifications:
• Bachelor's degree with emphasis in Health Insurance/Healthcare Administration, Finance or Business
• Minimum of six (6) years' related healthcare experience with three plus (3+) years in healthcare managed care business and provider network development and contracting
• Minimum of two (2) years of management experience
• Experience in establishing and/or developing productive and creative relationships with physicians/physician groups, hospital/health system administrators, and other health care industry leaders
• Knowledge of managed care contracting required in any of the following settings: Long Term Acute Care, Skilled Nursing/Transitional Care, Inpatient Rehab, Home Health and Hospice
• Understanding of various payment methodologies and fee schedule administration within the hospital/outpatient, ambulatory and professional provider practice settings
• Ability to develop and maintain excellent working relationships
• Excellent skills in: customer service, communication (written and verbal), interpersonal, critical thinking, organization, and computer operation
• Business knowledge and competency in accounting and analysis
• Working knowledge of regulatory requirements
• Ability to work independently and with a team
• Able to work under minimal supervision, exercising discretion and independent judgment to solve problems
• Team player and self-starter who is accurate and detail oriented
• Proficient in time management skills with the ability to prioritize a variety of duties
Responsibilities of all employees:
• Represent the Company professionally at all times through care delivered and/or services provided to all clients.
• Comply with all State, federal and local government regulations, maintaining a strong position against fraud and abuse.
• Comply with Company policies, procedures and standard practices.
• Observe the Company's health, safety and security practices.
• Maintain the confidentiality of patients, families, colleagues and other sensitive situations within the Company.
• Use resources in a fiscally responsible manner.
• Promote the Company through participation in community and professional organizations.
• Participate proactively in improving performance at the organizational, departmental and individual levels.
• Improve own professional knowledge and skill level.
• Advance electronic media skills.
• Support Company research and educational activities.
• Share expertise with co-workers both formally and informally.
• Participate in Quality Assessment and Performance Improvement activities as appropriate for the position.
Job Responsibilities:
• Manages managed care and provider network contract negotiations and maintenance.
• Oversees the efficient processing and accuracy of payor contracts claims payments.
• Organizes and facilitates payor in-service meetings.
• Acts as a resource for interdepartmental staff for administering contracts.
• Builds and maintains strong relationships with health plan partners and other industry stakeholders to develop brand recognition for the Company.
• Oversees facility credentialing and re-credentialing.
• Manages and monitors the third party payor report cards and establishes payor dashboards.
• Reviews applicable TPA reports for accuracy of claims' payments and denials.
• Performs root cause analysis to identify opportunities for claims processing process improvements and/or automation and implements new procedures.
• Performs other duties as assigned. $Competitive per HOUR Employment Type: Not specified