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 Senior Director of Managed Care and Contracting 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. Manages assigned staff and responsible for efficiency of work.
Qualifications:
• Bachelor's degree with emphasis in Health Insurance/Healthcare Administration, Finance or Business
• Minimum of eight (8) years' related healthcare experience with three plus (3+) years in healthcare managed care business and provider network development and contracting
• Minimum of five (5) 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
• Experience in payment methodologies and contracting in alternative payment models, shared savings and capitation
• Preferable experienced with third party payor(s)
• 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.
Leadership Success Factors:
• Communication. Express thoughts and ideas clearly. Adapt communication style to fit audience.
• Initiative. Originate action to achieve goals.
• Management Identification. Identify with and accept the problems and responsibilities of management.
• Judgment. Make realistic decisions based on logical assumptions which reflect factual information and consideration of organizational resources.
• Planning, Organizing and Controlling. Establish course of action for self and/or others to accomplish a specific goal; plan proper assignments of personnel and appropriate allocation of resources. Monitors results.
• Leadership. Use appropriate interpersonal styles and methods in guiding others toward task accomplishment.
• Work Standards. Set high goals or standards of performance for self and others. Compel others to perform
• Tolerance for Stress. Maintain stability of performance under pressure and/or opposition.
• Innovativeness. Generates and/or recognizes imaginative, creative solutions in work related situations.
• Delegation. Allocate decision making and other responsibilities effectively and appropriately.
• Staff Development. Develop the skills & competencies of subordinates.
• Organizational Sensitivity. Perceive the impact and the implications of decisions on other components of the organization.
• Ethics. Model highest standards of conduct and ethical behavior, adopting a strong position against fraud and abuse.
• Regulatory Compliance: Educate and monitor staff regarding their own and the organization's responsibilities for regulatory compliance.
Job Responsibilities :
• Manages managed care and provider network contract negotiations and maintenance.
• Oversees the efficient processing and accuracy of payor contracts claims payments.
• Manages direct reports including timely feedback and performance reviews. Responsible for accuracy and efficiency of assigned business areas.
• Organizes and facilitates payor in-service meetings.
• 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.
• Evaluates network to evaluate and address network adequacy requirements to support organizational growth.
• Reviews applicable dashboards and reports for accuracy of claims' payments and denials.
• Timely monitors and audits payor/ contractual performances on a quarterly and yearly basis.
• 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