How You’ll Help Transform Healthcare:
*The position is onsite in Roanoke, VA*
The Senior Director of Managed Care Contracting serves as a leader in organization management of payer contracting including portfolio, performance, execution, coordination and implementation of Value Based and Fee-For-Service arrangements for facility, physician, and ancillary agreements. You will assist with price modeling, hospital contract modeling, performance monitoring and auditing. Additionally you will facilitate the implementation of new processes & programs on a cross-department organizational structure.
Duties may include but not limited:
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Works in close cooperation with Vice President to ensure current contracts are managed well while assisting in developing innovative future contracts and relationships with payers and employers.
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Responsible for analysis and contracting of risk and non-risk contractual arrangements (including reimbursement and contractual language) between Carilion Clinic, owned and affiliated hospitals, ancillaries, Physicians (medical groups) and third-party payers for the provision of health care services to member/patients.  Payers include Commercial Insurance, Medicare Managed Care, Medicaid Managed Care, Third Party Administrators, Workers’ Compensation and Employers under Direct Contracts.
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Executes and monitors a payer performance and accountability structure which will administer, track and resolve contractual performance and business activity supporting the ability to maximize organization revenue, growth and retention.
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Achievement of annual and periodic goals for significant statistical indicators of revenue cycle performance including the management of hospital write-offs due to no authorization, medical necessity denials, or other reasons for writing-off any portion of an account.
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Oversee the Contract Management area to ensure Carilion is obtaining maximum reimbursement allowed by payer.
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Works to negotiate and implement delegated credentialling contracts in order to improve timeliness of provider enrollment with payer.
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Will be Carilion's representative on the VHHA Payer Advisory Council to assist in addressing payer concerns at a state level.
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Supports development, implementation, and compliance of Managed Care policies and procedures necessary to support operations.
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Supervises staff in contract management, contract compliance, modeling and financial analysis. Designs, establishes, and maintains an organizational structure and staffing to effectively accomplish the organization's goals and objectives: recruits, employs, trains and evaluates staff.
What We Require:
Education: Bachelor’s Degree in accounting, finance or business administration. Master’s degree in business administration or related field desirable.
Experience: Seven years experience in healthcare finance, accounting or financial planning
Licensure/Certifications/Registration: CPA desirable
About Carilion
This is Carilion Clinic ...
An organization where innovation happens, collaboration is expected and ideas are valued. A not-for-profit, mission-driven health system built on progress and partnerships. A courageous team that is always learning, never discouraged and forever curious.
Headquartered in Roanoke, Va., you will find a robust system of award winning hospitals, Level 1 and 3 trauma centers, Level 3 NICU, Institute of Orthopedics and Neurosciences, multi-specialty physician practices, and The Virginia Tech Carilion School of Medicine and Research Institute.
Carilion is where you can make your own path, make new discoveries and, most importantly, make a difference. Here, in a place where the air is clean, people are kind and life is good. Make your tomorrow with us.
Requisition Number: 144720
Employment Status: Full time
Location: CASB - Carilion Administrative Services Building
Shift: Day
Shift Details: Mon-Friday
Recruiter: MARK A MISKOVIC
Recruiter Phone:
Recruiter Email: mamiskovic@carilionclinic.org
For more information, contact the HR Service Center at 1-800-599-2537.
Equal Opportunity Employer
Minorities/Females/Protected Veterans/Individuals with Disabilities/Sexual Orientation/Gender Identity
Carilion Clinic is a drug-free workplace.