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Director of Payor Contracts & Reimbursements

at Family Allergy & Asthma in Memphis, Tennessee, United States

Job Description

Family Allergy and Asthma is a growing medical practice with offices located in multiple states. Headquartered in Louisville KY, the Financial Services Team is searching for a Director of Payor Contracts & Reimbursements to support the growing practice.

Servicing Asthma, Allergy, and Sleep medicine patients, the company has a complex and diverse business, with growing operations. As an Director, the candidate will direct the development, implementation, and maintenance of patient care and reimbursement contract programs with managed care plans, commercial and private payers for all states and locations of the company.

Position Summary

The Director of Payor Contracts & Reimbursements is responsible for demonstrating knowledge and application of job duties within scope of practice and functions as a leader, maintaining the utmost integrity and being accountable to his/her Director(s); respectfully interacts with all levels of staff; provides leadership and guidance, provides assistance, participates in department activities; promotes development and independence; adherence to the attendance policy; encourages socialization; advocates for the quality of life of our patients while maintaining compliance with all applicable laws, regulatory and organizational standards; supports the company’s core values.

Summary of Duties and Responsibilities:

+ Direct the development, implementation, and maintenance of patient care and reimbursement contract programs with managed care plans, commercial and private payers for all states and locations of the Company.

+ Develop payer strategies, relationships, and payer contracts to drive a clear and effective negotiation strategy, reimbursement structure, contract renewal planning process, and contract implementation in order to align with negotiation goals outlined by senior leadership.

+ Oversee and take direct responsibility for the terms and reimbursement criteria of all payer and reimbursement contracts.

+ Track and proactively manages all contracts, in advance of expiration to ensure successful continuation of revenue flow for all services.

+ Review and analyze contracts on a recurring, systematic basis.

+ Ability to evaluate profitability.

+ Establish and foster relationships with existing and new payers in expansion markets, including analysis of existing payer contracts for companies acquired by Family Allergy.

+ Collaborate with Director of Financial Services/Revenue Cycle to monitor payer compliance with contractual obligations.

+ Direct the credentialing & licensing team and outside third parties to ensure all credentialing is completed timely and accurately within established guidelines, securing capture of revenue for services provided by the Company.

+ Must possess the ability to self-direct and work independently, while seeking guidance when appropriate.

+ Exceptional verbal and written communication and presentation skills.

+ Exhibit a high degree of detail in work product and communication.

+ Assist with the integration of acquired practices to ensure new physicians and locations transition under the Company’s carrier contracts in a timely manner.

+ Analyze contracts and prepare recommendations, incorporate legal language within payer contracts that is consistent with the Company’s policy.

+ Analyze and negotiate bundled payment models that ensure the appropriate capture of services and revenue.

+ Work closely with relevant departments to coordinate all aspects of provider and company reimbursement.

+ Oversee the development, implementation and maintenance of appropriate department policies, standards and procedures; monitor compliance.

+ Create and manage SOPs.

+ Demonstrate ability to invest in and support the development of the team.

+ Demonstrate ability to successfully lead a department that has constant change and growth.

+ Manage day to day operations of all related sub-departments including, but not limited to: licensing and credentialing and revenue integrity.

+ Exhibit effective leadership by managing multiple simultaneous tasks and staff at varying levels.

+ Use proficient communication skills to maintain open communication with administration, physicians, managers, and internal employees as needed.

+ Demonstrate flexibility in a constantly changing environment and be a change champion.

+ Effectively manage time through strong organizational skills and prioritization.

+ Perform all tasks with a high emphasis on quality and timeliness.

+ Utilize proficient data analysis, report writing and electronic data retrieval skills to extract, compile, and present clear and concise information.

+ Develop an in-depth working knowledge of EMR and ancillary systems.

+ Utilize resources to improve processes and troubleshoot system and workflow concerns.

+ Accurately identify real/potential problems and implement solutions with follow through and communication.

+ Coach assigned team members and managers by providing feedback, constructive critique of work and document their job performance.

+ Have an understanding of coding rules and guidelines; ICD codes, reimbursement regulations for federal, state, commercial and private payers and programs.

+ Identify possible risks and revenue opportunities related to coding and revenue capture.

+ Demonstrate ability to communicate with and educate providers regarding changes.

Abilities, Knowledge and Skills

Effective communication skills to include:

1. Ability to fluently speak and read English.

2. Ability to read and interpret documents such as safety rules, handbooks, policies, and procedures.

3. Ability to communicate effectively, verbally and written, with all levels of staff, vendors, and patients.

Education, Prior Work Experience, Special Skill and Knowledge Requirements:

+ Bachelor’s Degree

+ Minimum of 5 years of progressively responsible payor reimbursement and contracting management for multi-state healthcare company

+ Minimum of 5 years of successful team leadership

+ Minimum of 5 years of EMR/EHR enhanced usage

+ Minimum of 3 years of Full Revenue Cycle management experience preferred

+ Minimum of 3 years of provider and company/facility credentialing, and licensing experience preferred

+ Distinguished Excel skills required

+ Must be well-versed in CMS guidelines

+ Must have working knowledge of bundled payment models

+ Acceptable results on Office of Inspector General, State Medicaid Exclusions, Abuse Registry Checks, Background Screenings, Drug Screen, and Sanction Checks.

EEOC Compliance:

Family Allergy & Asthma provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

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Job Posting: JC213242989

Posted On: May 13, 2022

Updated On: May 23, 2022