Alliance Family of Companies

Director of Contracts, Managed Care

US-TX-Irving
2 months ago
Job ID
2017-1973
# of Openings
1

Alliance Family of Companies

Job Overview:

The Director of Contracts, Managed Care is responsible for negotiating, drafting, filing and tracking all Payor contracts. Responsible for ensuring that the Company is on provider panel for top insurance providers for each state in which the Company does business or expands into.  Direct the appeals process.  Successfully negotiate favorable rates.  Supervises Contracting Specialist, Managed Care.

Essential Duties

Primary Job Responsibilities:

  • Create and implement the payor contracting strategy, benchmarks and internal standards for contract approval
  • Compile and analyze all the data for rate and market determinations
  • Determine and decide which payors to pursue in each market on a nationwide level
  • Serve as the primary contact for all payors and establish contact information with facilities and local payor representatives
  • Responsible for creating and maintaining relationships between payors and the Company
  • Maintain, manage and negotiate all commercial, governmental, TPA, complimentary networks and any other payor contracts deemed necessary to benefit the Company and generate additional revenue or member access through INN benefits
  • Process initial insurance and re-credentialing applications including completion and audits, correction of any errors prior to submission and regularly conduct status checks on re-credentialing application requests
  • Utilized internally to provide billing and VOB guidelines for all contracted payors
  • Assist the Business Development Team to identify and gather payor information as it pertains to new territories
  • Manage the overall process to receive Medicare Approval and Medicaid approval in all states
  • Supervise the completion of facility and physician credentialing applications, re-credentialing, new state licensing and renewals for Telemedx and any other entities deemed necessary by the organization
  • Manage all correspondence between AFC entities and contracted hospitals
  • Assist with any amendments needed to obtain new business with existing facilities
  • Audit and monitor contract performance on an ongoing basis
  • Perform other duties as assigned

General Job Responsibilities

Education/Experience:

  • High school diploma or equivalent required. Bachelor's Degree preferred
  • 5+ years’ experience within a managed care, insurance or provider setting (HMO, Point-of-Service, PPO, and provider network administration, and insurance operations) is required
  • 2+ years of experience in provider enrollment

General Job Requirements

Qualifications:

  • Knowledge of commercial insurance, Medicare and Medicaid benefits and contracts terms, and reimbursement structures
  • Proven negotiating skills
  • Extensive commercial payor experience
  • Demonstrated knowledge of Independent Diagnostic Testing Facility (IDTF) environment
  • Thorough understanding of reimbursements following Centers for Medicare and Medicaid payment models (e.g. RBRVS Relative Value Units), and per diem payments
  • Advanced knowledge of computer data entry, particularly in Microsoft Excel and a strong ability to navigate through any business-related software
  • Strong ability to multi-task efficiently, with a strong eye for accuracy and attention to detail
  • Superior oral and written communication skills
  • Ability to supervise contracting department employees
  • Ability to manage multiple projects and tasks with competing priorities

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