Sr. Director of Managed Care

HEALTHTRACKRX INC

68d

About The Position

The Sr. Director of Managed Care is responsible for obtaining new contracts (specifically IPAs in CA), improving medical policy, managed care contract management, negotiation, analysis interpretation of data, implementation, maintenance of the contract performance, frequent interaction (live meetings, Teams calls, email) and payer relations. The position coordinates, evaluates and oversees implementation of managed care contracting and related responsibilities. The position is responsible for coordination and communication between all key stakeholders. The Director of Managed Care is responsible for developing new and existing relationships with third party payers and Lab Benefit Managers (LBMs) to ensure favorable medical policy, competitive reimbursement rates and contract language attainable through the revenue cycle operations for the evaluation, negotiation, and implementation of payer contracts to ensure best possible reimbursement methodologies.

Requirements

• Bachelor’s degree in healthcare administration, business administration or related field, preferred.
• 10+ years of experience in healthcare contracting.
• Strong problem-solving abilities, adaptability to change.
• Computer skills to include Word, Excel, Power Point, Outlook.
• Strong interpersonal and communication skills, both written and oral, with varying levels of colleagues and/or management.
• Ability to manage open projects to the end with successful follow up.
• Attention to detail and strong organization skills.
• Ability to work independently within guidelines and company policies.
• Ability to effectively present information and respond to questions from leadership, clients, and customers.

Responsibilities

• Responsible for detailed understanding of health care/laboratory industry, market dynamics, trends, competitors, regulations, and payer environment.
• Creates and maintains professional relationships with payers and LBMs.
• Analyze available data to determine rates for contract negotiations.
• Implements and communicates contracting strategies in collaboration with leadership.
• Effectively manage and monitor third-party payer contracts to ensure a consistent strategic approach to managed care payer contracting.
• Negotiate new and renegotiate existing contracts.
• Review contracts and work with payers to finalize details, ensuring final terms are consistent with what was agreed by all parties, prior to recommending client signature.
• Maintain contract matrix.
• Maintain department files and contract repository in an organized, accurate and secure manner.
• Responding to internal and external customer inquiries regarding contractual issues/inquiries.
• Attending conferences.
• Travel 30% to payers, internal meetings, and conferences.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: Bachelor's degree