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Director of Payor Contracting (Remote Opportunity)

Alsana Thousand Oaks ,CA
  • Expired: over a month ago. Applications are no longer accepted.
Job Description

Job Title: Director of Payor Contracting
Location: Alsana
Reports to: Chief Financial Officer
FSLA Status: Exempt

 

Company Description:

Alsana offers new hope for clients with eating disorders. Combining data-driven, evidence-based treatment with a fresh approach that focuses on total health and wellness, we are Alsana. An Eating Recovery Community with 10 locations nationwide, we are here to provide superior care and help people on their journey to a recovered life.

Our culture is built on servant leadership, which places the client at the center of our model. We focus on caring for and empowering our teams so that they, in turn, can care for and empower our clients. Our culture creates a working environment of communication, collaboration, compassion and integrity that is necessary to establish high quality of care and successful outcomes for clients.

General Summary:

Under the supervision of the CFO and in collaboration with regional leadership, this role proactively develops and executes contracting strategies and tactics for payors to improve EBITDA and administration for the contracted book of business.


Responsibilities:

· Maintains relationships with vendors, payors, and other third parties in order to enhance strategic relationships.

· Executes new agreements with payors, as well as amendments to existing payor contracts for new locations, products and payment methodologies.

· Responds to all credentialing requests from payors to maintain Alsana’s good standing as a credentialed provider.

· Negotiates single-case agreement (SCAs) for noncontractes payors seeking to place a client with Alsana.

· In partnership with Alsana’s clinical leaders, analyzes and interprets clinical results to develop a compelling value proposition for payors for use in rate negotiations.

· Seeks to understand any variance in actual vs. expected outcomes, recommends interventions and takes appropriate action.

· Produces and reports on contractual performance.

· Identifies strategic opportunities to collaborate with payors on contracting initiatives to improve overall quality and patient engagement and to favorably impact total cost of care.

· Models contract proposals, drafts contract terms, reviews and recommends strategy, negotiates, and finalizes new /renewed /renegotiated health plan, health system, ACO or other payor agreements.

· Provides subject matter expertise and educational tools to company locations regarding participation in payor programs and contracts.

· Conducts market research to develop strategies.

· Monitors and maintains information system payor files for accurate and timely claim processing


Qualifications:

· Bachelor’s degree in Business or related field. Master’s degree preferred.

· Six (6+) years experience in managed care contracting.

· Contracting experience in behavioral health, in particular eating disorders.

· Demonstrated knowledge of managed care payor guidelines, credentialing and criteria for reimbursement.

· Experience with value-based contracting or P4P a plus.

· Familiar with insurance billing, coding and terminology.

· Strong analytic computer and software skills.

· Excellent interpersonal skills including excellent verbal and written communication skills.

· Demonstrated knowledge of customer service skills when responding to questions and other inquiries from internal and external customers.


Skills:

· Computer Skills – Must have general knowledge of PCs and be proficient in a Windows environment. Requires ability to access in a computer system.

· Interpersonal/Computer Skills – Must be able to read, write and speak fluently and effectively in English.

· Other Skills and Abilities – Good written and oral communication skills.

Core Competencies:

Attendance and Punctuality – Employee has reliable attendance and is punctual, adhering to their work and appointment schedules. The employee maintains accurate time records and makes every attempt to limits the need for overtime.

Quality and Efficiency of Work – Employee accurately completes assigned work within the timeline designated, while making efficient use of the organization’s resources. Employee participates in all organizational performance improvement initiatives.

Professionalism – Employee upholds client confidentiality and maintains professional boundaries, demeanor, dress and interaction with clients, family members, visitors and coworkers. The employee strives to provide outstanding customer service and promote a positive reputation for the organization.

Ethical and Legal Compliance – Employee performs all duties to the highest ethical standard and complies with all organizational policies regarding ethical business practices and standards of patient care. The employee complies with all standards established by the Missouri Department of Mental Health and any other agency accrediting the organization.

Employee Partnership – Employee maintains collaborative peer relationships and demonstrates courtesy and respect of others. The employee acts as a role model by displaying enthusiasm, positive problem solving and commitment to help both coworkers and the organization reach its’ goals.

Company Description
Combining data-driven, evidence-based treatment with a fresh, compassionate approach, Alsana focuses on total health and wellness in recovery from eating disorders and related conditions. A recovery community with five locations nationwide. We provide superior and committed care to help those on their journey to a healthy and successful recovery.

From the Latin roots meaning “all” or “total health,” Alsana offers a new philosophy of care centered on our clients’ full well-being. We address the aspects of eating disorders that often go untreated in traditional recovery programs.

Our culture is built on servant leadership, which places the client at the center of our model. We also focus on caring for and empowering our teams so they can equally care for and empower our clients.

Our culture creates a working environment of communication, collaboration, compassion and integrity—all of which are necessary to craft unique treatment plans tailored to our clients’ needs and outcomes.

Alsana

Why Work Here?

Our culture is built on servant leadership, which places the client at the center of our Adaptive Care Model.

Combining data-driven, evidence-based treatment with a fresh, compassionate approach, Alsana focuses on total health and wellness in recovery from eating disorders and related conditions. A recovery community with five locations nationwide. We provide superior and committed care to help those on their journey to a healthy and successful recovery. From the Latin roots meaning “all” or “total health,” Alsana offers a new philosophy of care centered on our clients’ full well-being. We address the aspects of eating disorders that often go untreated in traditional recovery programs. Our culture is built on servant leadership, which places the client at the center of our model. We also focus on caring for and empowering our teams so they can equally care for and empower our clients. Our culture creates a working environment of communication, collaboration, compassion and integrity—all of which are necessary to craft unique treatment plans tailored to our clients’ needs and outcomes.

Address

Thousand Oaks, CA
91320 USA

Website