Our client is an industry-leading medical device company committed to quality, cutting-edge technology, and people, are looking for an individual to join their leadership team. This company is experiencing an exciting period of growth and expansion. The company’s culture is very collaborative with a deep commitment to the customers they serve today and in the future.
Responsibilities: This position will be responsible for opening new markets for this company and lead the Company’s managed care contracting functions, which include payor contract identification, negotiation, procurement, and performance monitoring, management of payor relationships, and credentialing, which includes enrollment and application management. This person will call on and present medical devices for inclusion in health plans, by physician offices, hospitals, and other healthcare agencies as required. This person will ensure compliance with the appropriate accrediting and regulatory agencies. This person will work with and provide mentorship to credentialing staff in the day-to-day management of the overall credentialing process and database management.
Requirements: Bachelor’s Degree in healthcare management or related field. Master’s degree preferred. • Minimum seven (7) years’ experience working with a healthcare company or health plan directly focused on payor contracting and facility/provider enrollment. Minimum three (3) years in a management (preferably director) role.
- Strong technical knowledge of payor contracting, including language review, contract format and structure, and reimbursement methodologies
- Knowledge and skills: Payor Contracting: Manage all components of the contract negotiation process. Identify the key payors in new markets into which the Company enters. Lead the rate and language negotiation discussions with the payors. Work with the Company’s analytical resources and CFO to ensure negotiated rates are acceptable and will add value. Provide strategic leadership around negotiating contracts for closed networks.
- Work with Sales and Operations management to identify and implement contracting opportunities for revenue improvement. Payor Relations: Develop productive and professional relationships with contracted payors. Works with the Company’s Billing Office as needed when rates received by payors vary from the contract. Discuss/resolve claim issues resulting from contract interpretation and/or language.
- Meet regularly with the Business Office to discuss changes in payor policies affecting reimbursement or administration and any emerging payor concerns prior to incurring high-dollar losses. Keep abreast of marketplace changes for payors, networks, reimbursement issues, and changes in legislation or in guidelines at the state and federal levels.
- Credentialing: Oversee the process of health plan enrollment / credentialing applications for facilities and licensed providers with all government and commercial health plans. Oversee the credentialing staff efforts to ensure that all payor contracts are renewed prior to expiration.
Ann Grogan & Associates
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