Director of Managed Care

KabaFusion•Los Angeles, CA

1d•$175,000 - $200,000

About The Position

Responsible for oversight of the managed care contracts through implementation of systems assuring contract compliance, contract data management, and business development as it relates to health plans/payors. Overall field support will include but it not limited to negotiations, contract interpretations/clarification, case management, education and resources. Understanding claims and intervention when required as the liaison between KabaFusion and health plan/payors. Understanding of current law and regulations and as may be directed by AVP of managed care.

Requirements

Knowledge of managed care contracting billing and negotiations skills a must
Strong oral and written communication skills
Strong problem solving skills
Exceptional computer skills specially in Microsoft Word, Excel and Outlook
Strong interpersonal skills to interface effectively with all levels of personnel
Ability to maintain confidential company information
Attention to detail
Ability to self-direct work and effectively multi-task
Bachelor’s degree in Business or related experience
Minimum of 7 years of experience in health care industry
At least 3 years managed care contracting, billing and negotiations skills required

Nice To Haves

infusion experience a plus

Responsibilities

Contract negotiation/renegotiation with health plans, medical groups, IPAs or other managed care payor sources.
Ability to establish and maintain professional business relationships with health plans contract managers.
Annual rate negotiations
Knowledge/Understanding of Division of Financial Responsibility of payors
Knowledge/Understanding of varies payor product lines
Knowledge of and routine review of contract language
Assure Pharmacies remain fully credentialed with all payors to include management of documents required for credentialing process
Provide assessment and recommendations for contractual operation of managed care patients
Provide training support/resources to the field related to managing/analyzing costs
Knowledge of high cost medications /supplies/DME and education/review of pharmacy costs to identify exclusions and guidance to AR on collecting
Implement cost reduction measures for the provision of ancillary services of managed care include analysis, recommendations, etc.
Assist with creation and implementation of managed care policy and procedures
Update/maintain managed care manuals cost analysis and contracts
Ensure all contracts meet company standards and are fully executed
Other duties as assigned.