Director Managed Care Contracting and Credentialing

POSITION DESCRIPTION

The Director of Managed Care Contracting and Credentialing is responsible for contract assessment, negotiation, financial analysis, problem solving, revenue modeling, and advanced analytics. This position will work with the Central Business Offices to monitor changes in payment schedules, changing reimbursements, changes in healthcare delivery models, and expiration dates of payer contracts. The Managed Care Coordinator will act as a liaison between the Central Business Offices and third-party payers.

FUNCTIONS AND JOB RESPONSIBILITIES

• Coordinates negotiation and full implementation of commercial contracts with third party payers, including confirmation of the completion of rate loading in payer systems for all applicable lines of business
• Maintains files with all pertinent information and licenses for each facility for health plan contract credentialing purposes
• Identifies and communicates to senior management - any gaps or breakdowns in managed care contracting workflows
• Monitors and communicates changes in payment schedules, reimbursements, and expiration dates of third-party payer contracts
• Maintains and updates established department documents related to contracting functions
• Assist the business office teams with monitoring the performance of managed care contracts to ensure accurate claims processing, including level of underpayments and overpayments by providers
• Creates and delivers education material regarding contracts and implications
• Informs senior management of any changes in reimbursement or regulatory requirements
• Ensures all required processes related to strategic pricing, legal, reporting and communication are deployed to maximize contract performance and yield
• Completes applications for payer contracts and analyzes contract offers from payers to ensure offerings are competitive within the market
• Reviews contract language for financial, legal and operational impact and to ensure compliance with State and Federal Regulatory Agencies
• Performs other duties as assigned, within skillsets and abilities

COMPETENCIES, SKILLS, AND ABILITIES

• Ability to handle complex contract negotiations
• Proven ability to close negotiations in a timely manner that yield competitive and appropriate levels of reimbursement
• Proficient knowledge of medical contracting methodologies and claims pricing/reimbursement strategies
• Independent thinker and decision maker
• Strong analytical and problem-solving skills with attention to detail
• Excellent verbal and written communication
• Strategic business partner
• Ability to prioritize and manage multiple projects
• Solid ability to learn new technologies and possess the technical aptitude required to understand flow of data through systems as well as system interaction
• Ability to effectively communicate both verbally and written with internal and external customers with the ability to demonstrate empathy, compassion, courtesy, and respect for privacy

EDUCATION AND EXPERIENCE REQUIREMENTS

• Bachelor's Degree preferred
• Five years of experience in working with Managed Care/Third Party Payers within the healthcare industry
• Previous healthcare contract negotiation experience
• Excellent computer skills and thorough knowledge of MS Excel and MS Word
• Critical thinking skills necessary to plan, coordinate, and execute strategic initiative
• Experience in the Louisiana and Texas markets are preferred