Director of Managed Care Development
Elderwood - Williamsville, NY

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Elderwood Administrative Services
Williamsville, NY 14221

APPLY TODAY @ www.elderwood.com

Department: Census Development

Position Summary:
Responsible to support the Director of Census Development in all functions related to Managed Care & Commercial Payers, including but not limited to new contract negotiation, development of provider relationships, and contract warehousing, review/assessment/monitoring of existing contracts. This position will serve as resource to accounts receivable staff in billing and collection activity through training and audit functions and through the management of associated Policy and Procedures for the organization.

Supervision & Accountability: Director of Census Development

Qualifications:

  • A Bachelor’s Degree is required (MBA or MHA is preferred).
  • A strong healthcare background with knowledge of hospitals and medical providers, and have experience dealing with commercial payers and managed Medicare and managed Medicaid organizations.
  • Experience in contract negotiation, language scripting and administration is required.
  • Must be familiar with hospital, physician, Medicare, Medicaid and ancillary commercial reimbursement methodologies and understand healthcare contract terminology.
  • Must be familiar with federal and state laws as they relate to Medicare and Medicaid managed care payment structures.
  • Strong communication skills are necessary for this person to efficiently and effectively work with providers and payers. Proficiency in Microsoft Word/Outlook/Excel required and experience with web based research preferred.
  • Must be outgoing, results oriented and have the ability to work as a team.
  • Attention to detail is required.
  • Minimum of 3 years’ experience in a managed care payer environment dealing with provider contract negotiations and reimbursement preferred.
  • Travel will be required.
  • Professional business attire and presentation required.

Primary Duties:

  • Seek opportunities to engage new contractor relationships.
  • Develop new contract opportunities including negotiation of new contracts as well as monitoring needed or required updates, adjustments and changes to existing contracts.
  • Script, negotiate and finalize contracts for implementation by organization.
  • Ensure appropriate credentialing of all contract relationships is maintained current as applicable.
  • Interface with organization’s clinical and pharmaceutical leadership teams in developing contractual proposals.
  • Detail contracts and track changes (redline), build spreadsheets for contract inventory, track contract negotiation activity, pricing structure, opportunities for carve outs as deemed appropriate and in response to past and future changes in services provided.
  • Keep current with changes to federal and state regulations as they affect contract structure in providing services.
  • Develop, maintain and keep current Policy and Procedure Manuals for facility and organizational use.
  • Provide education to various levels of staff; develop and maintain written Training Manual and Handbook for facility clinical and billing staff use and reference.
  • Oversee and serve as resource to the billing functions of Accounts Receivable staff as they relate to payment and collection for contracted services.
  • Set up communication systems and channels to facilitate the growth of the business line.
  • Establish effective audit and monitoring systems for appropriate billing and efficient collection of payment for services rendered.
  • Develop and provide for ongoing reporting to appropriate individuals as required/requested including but not limited to revenue and product utilization data.

EOE


About this company
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Post Acute Partners, owner of Elderwood since July 2013, was established in January 2010 in response to national health care reform and the...