Director, Managed Care Contracting

WakeMed Health & Hospitals • Raleigh, NC

12h

About The Position

The Director, Managed Care Contracting is responsible for utilizing business and industry expertise, accepts responsibility for all activities in the Managed Care department applying to and impacting WakeMed facilities' managed care contracts including budgeting, analysis, contract modeling, negotiation meetings and monitoring and reporting of payor contracts' compliance. Directs organizations efforts at building relationships with area managed care plans. Directly manages and develops a portfolio of managed care contracts. Directs contracting strategy for hospitals, Healthplexes, hospital outpatient departments, Home Health and Rehab divisions. Develops payment models for facility managed care contracts. Oversees facility what-if modeling analysis performed in STRATA modeling tool. Oversees the following noncontracting Managed Care responsibilities: hospital contract loading in EPIC, hospital payment variances, facility credentialing. Works with CFO, Vice President of Finance, Finance Directors and financial analysts to analyze feasibility of different payment methodologies/utilization patterns and the impact on WakeMed. Monitors market trends and competitive managed care products to develop strategy recommendations. Works with WakeMed's accountable care organization to coordinate contracting efforts and outcomes beneficial to WakeMed providers. When requested, interfaces with external and third party auditors; prepares and defends contract questions and challenges; maintains quality of work and creates value through knowledge and experience with governmental regulations and processes. Adheres to service and workforce excellence by maintaining knowledge of third-party regulations (CMS, NCDHHS, DOI, etc.) for all payors, including governmental and commercial payors. Oversees problem solving related to contract terms, payment promptness, payor-member issues, and physician-payor relations. Works closely with other Finance teams to ensure reported data is reliable. Plans and organizes activities for personnel to ensure deadlines and goals are met. Supervises and trains staff to improve and maintain the accuracy and timeliness of contacts.

Requirements

• Bachelor's Degree in Business Administration, Healthcare Management, or Accounting Required
• College Courses in Finance Required
• 10 Years of Managed Care Contracting Experience Required

Nice To Haves

• Master's Degree in a Related Field Preferred
• Certified Healthcare Financial Professional Preferred
• Certified Public Accountant Preferred
• Certified Revenue Cycle Representative Preferred
• 5 Years of Healthcare - Multi-Hospital System Experience Preferred

Responsibilities

• Utilizes business and industry expertise to manage all activities in the Managed Care department impacting WakeMed facilities' managed care contracts.
• Oversees budgeting, analysis, contract modeling, negotiation meetings, and monitoring/reporting of payor contract compliance.
• Directs the organization's efforts in building relationships with area managed care plans.
• Manages and develops a portfolio of managed care contracts.
• Directs contracting strategy for hospitals, Healthplexes, hospital outpatient departments, Home Health, and Rehab divisions.
• Develops payment models for facility managed care contracts.
• Oversees facility 'what-if' modeling analysis using the STRATA modeling tool.
• Manages non-contracting Managed Care responsibilities including hospital contract loading in EPIC, hospital payment variances, and facility credentialing.
• Collaborates with CFO, Vice President of Finance, Finance Directors, and financial analysts to assess the feasibility of different payment methodologies and utilization patterns and their impact on WakeMed.
• Monitors market trends and competitive managed care products to develop strategy recommendations.
• Works with WakeMed's accountable care organization to coordinate contracting efforts and outcomes beneficial to WakeMed providers.
• Interfaces with external and third-party auditors when requested, preparing and defending contract questions and challenges.
• Maintains quality of work and creates value through knowledge and experience with governmental regulations and processes.
• Adheres to service and workforce excellence by maintaining knowledge of third-party regulations (CMS, NCDHHS, DOI, etc.) for all payors.
• Oversees problem-solving related to contract terms, payment promptness, payor-member issues, and physician-payor relations.
• Works closely with other Finance teams to ensure reported data is reliable.
• Plans and organizes activities for personnel to ensure deadlines and goals are met.
• Supervises and trains staff to improve and maintain the accuracy and timeliness of contacts.

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Number of Employees: 1-10 employees