What are the responsibilities and job description for the Director of Revenue Contracting position at Akido?
Akido is rebuilding the healthcare experience from the ground up. Through early interventions designed around social determinants of health (SDoH), world-class care focused on chronic disease, and human-centered technology, we believe we can build a healthcare model that allows for all patients to live their fullest lives. We are a fast-growing, impact-focused, Y Combinator company created out of the University of Southern California's D-Health Lab with the idea that empowering government, healthcare, and nonprofit services with population-based data could help usher in a new era of preventive public health. Today we are building a full stack medical network that leverages our predictive capabilities to provide a frictionless experience for both our patients and care providers.
Our Director of Contracts oversees and directs the daily managed care operations, including but not limited to such areas as managed care financial reporting, utilization management, claims processing, outside provider contracting, and information systems development (Eg: eligibility, claims, remittance, benefits and other managed care systems). Implements problem resolution and maintains relationships with HMO representatives to ensure effective communications. Analyzes and advises on managed care product development, capitation and operational planning.
Qualifications: To perform this job successfully, an individual must be able to perform each essential function satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Experience: Bachelor's Degree required (prefer degree in Healthcare or Business related field). Five years of health care operations management experience in clinic and/or group practice, third party administration setting, or HMO experience in capitation management. Understanding of prepaid reimbursement, managed care industry, and operational as well as legal aspects.
Skills: Ability to read and speak English fluently. Ability to analyze, interpret and summarize medical contracts and health maintenance agreements. Ability to write reports, correspondence, memos and policy and procedures. Ability to respond to inquiries, complaints from customers, regulatory agencies or staff. Must be able to effectively and professionally communicate and present information, both verbally and written, to customers, patients, management, other employees of the organization. Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.
Job Functions:
- Analyze and review HMO contracts to assist legal council with contract negotiations.
- Participate in ongoing education programs for physicians and staff to deploy clinic-wide managed care procedures. Develop reference, resource, and education materials for staff. Act as consultant and educator for both internal and external clients.
- Provide written communication to Akido management to ensure applicable staff is properly notified of specific parameters as defined in HMO contracts.
- Oversee operations of claims and recovery staff to ensure effective management within department. Guides and directs Prepaid Manager as applicable.
- Oversee operations of Utilization Management department to ensure effective management within department. Guides and directs Manager of Utilization Management as applicable.
- Oversee and directs Provider Contracts manager to ensure timely resolution to negotiations.
- Oversees all managed care department operations to ensure compliance with health plan, state and federal and regulatory agencies.
- Review and approve policies and procedures for all managed care departments.
- Analyze profitability of current and proposed prepaid contracts.
- Coordinate and communicate with Finance, Business Office, and MIS departments to ensure timely and accurate data analysis on all prepaid contracts.
- Act as liaison between HMO payers and internal departments within Akido Labs to ensure effective communication as applicable.
- Facilitate problem resolution for complex issues that arise between Akido Labs and prepaid payers.
- Lead special projects as requested by the President/ COO.
Note: (other duties may be assigned, deleted or changed at any time, at the discretion of management, formally, or informally, either verbally or in writing).
Other Responsibilities:
- Assume responsibility for initiating a pleasant patient-oriented atmosphere by displaying a professional attitude through performance, appearance, and demeanor.
- Maintain work area in a clean and organized manner.
- Uphold and support the philosophy, objectives, and policies of Akido.
- Adhere to Safety Program as outlined in Core Competencies and Injury, Illness and Prevention Program.
- Maintains professional composure and confidence during stressful situations.
- Maintains open communication using appropriate chain of command regarding issues.
- Continuously displays a positive, "can do" attitude within the department and across departmental lines to contribute to the overall customer service program in place at Akido.