Assistant Director, Contracting & Balance Billing

1199SEIU Funds•New York, NY

About The Position

This role plans, strategizes, and oversees the daily operations of the Balance Billing & Fee Negotiation, and Contracting units within the Provider Relations department. The position involves managing negotiations related to No Surprises Act (NSA) and Independent Dispute Resolution (IDR), as well as other member balance billing issues with providers and facilities. It also includes overseeing contracting with various facility types, vendors, and ancillary providers, ensuring contract compliance, and maintaining contract documents. The role facilitates contract rate and term negotiations, monitors key metrics, and collaborates with external fiduciaries on rate implementation. Additionally, it involves managing staff, upholding organizational values, and working collaboratively with other departments.

Requirements

Bachelor’s degree in business or health related field required
Minimum six (6) years relevant experience in managed care, contracting, and network management
Four (4) year supervisory experience required
Knowledge of fee negotiations, reimbursement methodology, and contract language review process
Broad knowledge and understanding of applicable laws, regulations, requirements, and protocols in compliance and adherence (ERISA, DOL, HIPAA, PHI, ACA)
Excellent written, organizational and communication skills; detail-oriented with interpersonal and team building skills
Knowledge of hospital and medical claims adjudication process, medical billing and coding terminology, and Medicare and industry billing policies and procedures
Proven multi-tasking skills and ability to meet critical deadlines
Intermediate level of Microsoft Suite/365, Word and Excel

Nice To Haves

Master’s Degree preferred

Responsibilities

Plan, strategize and oversee daily operations of the Balance Billing & Fee Negotiation, and Contracting units under Provider Relations department
Oversee and manage the Balance Billing & Fee Negotiation unit, an area responsible for handling NSA (No Surprises Act) and IDR (Independent Dispute Resolution negotiations, and other negotiations associated with members balance billed by providers including facilities for voluntary and involuntary access to participating and non-participating providers by eliminating and reducing out-of-pocket cost incurred by the members; oversee and negotiate rates for out of network hospital and medical services
Oversee and manage contracting activities with all facility type, including freestanding ASCs, vendors, and ancillary providers and enforce contract compliance
Responsible for the maintenance of the contract documents, including professional agreements, letters of agreement, amendments, ancillary, facility and hospital services agreements; ensure that any changes to the contract templates are approved by the Legal Department
Facilitate the negotiation of contract rate and terms upon requests within applicable financial and operational goals; capture, monitor and report on key metrics
Collaborate with the Funds’ outside fiduciary to implement rates for inpatient and outpatient hospitals services; respond to provider issues and concerns to ensure high volume hospitals, vendors, and networks are managed effectively
Manage staff in accordance with established department procedures, Human Resources guidelines and provisions of the Collective Bargaining Agreement
Honor commitments consistent with organization and department’s vision, behave ethically and act with integrity, and communicate with candor
Be passionate about the members we service, set high expectations and be accountable, collaborate with other departments and other Provider Relations areas to develop or refine shared workflows
Perform additional duties and projects as assigned by management