Director of Managed Care Contracting and Credentialing

Job Description

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. The Managed Care Coordinator 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 :

Education and Experience Requirements :

Houston's oldest hospital is GROWING!

Welcome to St. Joseph Medical Center (SJMC), Houston's first and only downtown hospital delivering world-class care for the last 137 years and looking forward to the next century of exceptional care to Houstonians when they need us most.

Whether it's for a scheduled surgery, the birth of a baby, an unexpected emergency, or an outpatient visit, we have staff available around the clock to provide you access to immediate, quality health care. SJMC has been providing health care services to Greater Houston residents for over 130 years, which should give you great comfort in knowing that we have a great tradition of caring for our community. We strive to meet our patients' expectations and encourage our patients to provide us with feedback on how we can help them have the best experience possible while they're in our care.

Over the last years we have expanded our services to include the Advanced Wound Care Center, Comprehensive Cardiac and Vascular Services, the Women's Center, the St. Joseph Maternal Fetal Medicine Center, and a Weight Loss Surgery Program, just to name a few. As you work with our physicians, nurses, case managers, educators, and other staff, you will be guided through your health care journey, from diagnosis to treatment, with compassion every step of the way.

Diversity, equity, inclusion, and belonging are at the foundation of the care St Joseph Medical Center provides to our community we are privileged to support in all of our employment practices. We do not discriminate on the grounds of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity, or expression or any other non-job-related characteristic.