Director, Payor Relations & Regulatory Affairs

Abbott • Livermore, CA

2d • $172,000 - $344,000

About The Position

Abbott is a global healthcare leader that helps people live more fully at all stages of life. Our portfolio of life-changing technologies spans the spectrum of healthcare, with leading businesses and products in diagnostics, medical devices, nutritionals and branded generic medicines. Our 114,000 colleagues serve people in more than 160 countries. JOB DESCRIPTION: Director, Payor Relations & Regulatory Affairs The Opportunity Acelis Connected Health’s (ACH) DME & IDTF businesses operate across all states in the US with several hundred payor plans to serve it’s 80,000+ patients on service. This Director, Payor Relations and Regulatory Affairs will be accountable to develop strategies and drive ongoing activities that maintain and expand payor coverage while ensuring ACH remains compliant standards required by The Joint Commission, state agencies, and CMS (Medicare/Medicaid). These activities include leading the development, implementation, and monitoring of processes related to commercial payor contracting, state licensing, and CMS enrollments. These processes span across all lines of business at ACH.

Requirements

• Bachelor’s Degree in a business discipline
• 10+ years relevant experience in payor contracting at a healthcare provider, payor, or network
• 5+ years directly interacting with regulatory agencies
• Demonstrated ability to develop, improve, and monitor commercial contracting processes
• Ability to work independently and managing competing priorities routinely.

Nice To Haves

• Master’s Degree in related field
• 5+ years experience in payor contracting within the DME/IDTF provider space
• 5+ years experience working directly with CMS (Medicare/Medicaid), The Joint Commission, and state licensing agencies

Responsibilities

• Directly hires, develops, and drives engagement for team members across Payor Relations and Regulatory departments
• Oversees essential activities and process improvement related to commercial payor contracting across all lines of business; specific contracting activities include, but are not limited to: Contract redlining Contract implementation Contract monitoring Contract management, including initial & ongoing credentialing Payor escalation management, including payment discrepancy resolution
• Oversees essential activities and process improvement related to regulatory affairs for ACH; specific contracting activities include, but are not limited to: State licensing Medicare and Medicaid enrollments The Joint Commission Accreditation
• Maintains governance processes to ensure alignment to contracting and regulatory business expectations with cross-functional stakeholders, including: finance, commercial operations, revenue cycle management, legal, and the office of ethics & compliance
• Develops, maintains, and presents to leadership the KPIs/metrics related to areas of responsibility
• Contributes to business strategies related to commercial contracting, payor management, and regulatory compliance; examples include: patient access, pricing, payor management, Medicaid advocacy, state licensing applications, and accreditations.

Benefits

• Participants who complete a short wellness assessment qualify for FREE coverage in our HIP PPO medical plan. Free coverage applies in the next calendar year.
• Learn more about our health and wellness benefits, which provide the security to help you and your family live full lives: www.abbottbenefits.com
• Follow your career aspirations to Abbott for diverse opportunities with a company that can help you build your future and live your best life.
• Abbott is an Equal Opportunity Employer, committed to employee diversity.

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Number of Employees: 5,001-10,000 employees