JOB TITLE: Managed Care Executive
REPORTS TO: Executive Vice President, COO
MAJOR FUNCTIONS: Plans, directs and oversees all aspects of the organization’s managed care function. Responsible for directing and implementing managed care systems for reimbursement programs. Manages contracts and reviews reimbursement levels on behavioral health managed care agreements ensuring that proper payment practices are utilized and that all regulatory principles are adhered to within all departments.
SPECIFIC DUTIES AND RESPONSIBILITIES:
1. Develop, negotiate and monitor implementation of all behavioral health managed care contracts.
2. Maintain regular communication with payor representatives.
3. Ensure maximum revenue opportunities are captured.
4. Conduct data analyses/reports to the CFO/CEO/COO on status of managed care operations.
5. Act as a managed care resource to all applicable departments within the organization.
6. Facilitate managed care education to internal staff.
7. Perform other management related tasks as needed.
Bachelor’s Degree required in Business or related field (Master’s preferred)
Years of Relevant Experience
Minimum Seven years experience in health contracting/managed care/payor financial analysis is preferred Third-party reimbursement background and/or experience Contracting experience with managed care accounts
Deep understanding of managed care practices, principles and payor reimbursement methodologies. Strong interpersonal and customer service skills – excellent group presentation skills Strong analytical skills Self-starter and results driven · Ability to apply knowledge of medical terminology and payor reimbursement methodologies including all current managed care requirements and strategies.
- Ability to work under stress and tight deadlines.
- Computer proficiency and literacy in Excel, Word, Power Point and other Outlook or designated programs.
- Significant knowledge and understanding of contract language.
- Strong organizational and time management skills.