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National Director, Payer Solutions

Company: TridentCare
Location: Plano
Posted on: September 15, 2020

Job Description:

This position is responsible for managed care contract management and administration. In this role, the national director works with each Trident VP of Revenue Cycle directly and the sales team to identify contracting opportunities. In addition the national director ensures contracts are analyzed for profitability and that payments are audited to ensure accuracy.DUTIES AND RESPONSIBILITIES:Develops, manages and oversees the process to ensure prompt response and completion of managed care proposals (letters of interest) and/or other required payers' paperwork:Compliantly complete pertinent applications as required by the payerVett through contracts ensuring terms and language meets with needs of each Trident entity providing mutual indemnificationTrack the status of pending contracts for resolutionReview and discuss proposals and responses with applicable leadership membersWork with System Support as needed to load and test new filing formats for field requirementsWork with other departments as necessary to ensure contract terms can be met and system parameters are properly alignedCommunicate other payer contracting changes to all areas impacted, once contract is executed.Coordinate and audit the process of non-government payer related audits and inquiriesDevelop and execute contract documents which contain adequate provisions to ensure that the company's goals and objectives are metPrepare cost benefit analysis for pricing determinations and opting for in-network/out-of-network managed careEnsure that the fee schedules, tied to Medicare, are updated and currentDocument the terms, fee schedules, and other billing requirements for managed care payer contractsEvaluate and monitor contracts to determine the overall profitability including renegotiating or terminating contracts if necessaryCreate a list for billing of key contract highlights (matrix) for billing and sales teamsResearch and develop solutions to address payer/contract related issuesIdentify possible problem payers/reimbursement trends negatively impacting cash collectionsEducate internal and external clients/customers about any exceptional payer requirements such as Prior AuthorizationAssist in the development of contract strategiesMaintain electronic copies of all signed payer contracts within the federal, state and local guidelinesCommunicate new and amended contracts to Billing, finance, and other departments as necessaryAct as a liaison between Billing A/R team and payer relations when A/R issues escalateOther duties as assigned EXPERIENCE (minimum requirements): 8+ years minimal experience in health care billing/accounting requiredPrior managed care payer contractual negotiations preferredBachelor's degree preferredExperience with contract management software preferredComprehensive knowledge of managed care for non-government payor relations programsSKILLS/ABILITIES: Strong managerial acumen in setting direction and managing execution to achieve goals.Experience in managed care contract terminology and reimbursement negotiations.Strong managerial competencies in the areas of leadership and team development, managerial coaching and mentoring, and situational assessment skills. Proven track record in building and developing high performing teams.Knowledge of best practices in revenue cycle environment.Demonstrated ability to assess current processes and implement best practices.Continuous improvement mindset with experience leading and implementing change.Strong presentation and communication skills, with the ability to communicate to a wide range of audiences from senior executives to front-line employees.Results oriented and strong analytical skills.Familiarity with computerized applications for data collection and report creation is essential.PHYSICAL DEMANDS:The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.While performing the duties of this job, the employee is frequently required to stand; to handle or feel; to talk and to hear. The employee is occasionally required to walk, sit, reach with hands and arms and stoop, kneel, crouch or crawl. The employee must occasionally lift and or move up to 15 pounds. Specific vision abilities required by this job include close vision, depth perception and ability to adjust focus.WORK ENVIRONMENT:Standard office environment.RequirementsCapable of carrying out a given task with all details necessary to get the task done wellInspires teammates to follow themmanaged care payer/contractual negotiations experiencehealthcare billing/accounting

Keywords: TridentCare, Plano , National Director, Payer Solutions, Executive , Plano, Texas

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