Our client is a nationally recognized healthcare solutions provider with over 10,000 employees and they are seeking a Director of Managed Care for this newly created position in Florida.
The primary objective is to evaluate, negotiate, and secure agreement to new and existing contracts with health insurance benefit payers. Responsibilities include but are not limited to: managing the contract assignment process with acquisitions, leading contract negotiations, assisting in the resolution of contract payment issues, analyzing contract performance, and working on strategic and operational partnerships with payers. Responsible for providing independent support and direction to Regional Managed Care staff.
Corporate office duties:
- Manage negotiation, implementation and service of select national delegated credentialing agreements.
- Monitor the capitation contract currently in place. Perform annual analysis of the utilization to determine the fee-for-service equivalent and make recommendations for any improvements.
- Liaison to Corporate and Regional Patient Accounts for major questions and service issues on the 6 existing national agreements.
- Strategic thinker in Reimbursement Methodologies around Radiology.
- Office, Based, Hospital Based, Tele Radiology. Minimum 5 years Healthcare Experience in Managed Care Contracting Ability to pull together presentations and present to C Level and external partners.
- Travel 40% - 50%.
- What are the nice-to-have skills?
- Value Based Payment Experience.
This position reports to the COO.
- Bachelor’s Degree in related field.
- Master’s Degree in related field.
- 5 years in health insurance, patient accounting and/or managed care including payer or provider contracting and supervisory/management experience.
- Experience negotiating managed care contracts with third party payers.
- Regarding physician professional service compensation issues.
- Experience with fee schedule, case rate, per diem, and capitation reimbursement.| Familiar with patient accounting tasks including billing, collections, and reimbursement analysis.
- Strategic planning and marketing experience.
Highly competitive salary and benefits packaged offered AND a 20% BONUS.
For prompt and confidential consideration, please apply to the link below: