What are the responsibilities and job description for the Director of Managed Care Contracting and Credentialing 1431374 position at Palmetto General Hospital?

Job Description

Director, Managed Care Contracting and Credentialing

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. In addition, the Director of Managed Care Contracting and Credentialing will act as a liaison between the Central Business Offices and third-party payers.

Essential 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, South Florida market preferred

Excellent computer skills and thorough knowledge of MS Excel and MS Word

Critical thinking skills necessary to plan, coordinate, and execute strategic initiatives

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