Director, Payer Network Management

4 weeks ago

Atlanta, United States CND Life Sciences Full time

The Director, Payer Network Management will supervise the development and maintenance of strategic business relationships with healthcare reimbursement entities to support the financial performance and market share goals for CND's evolving portfolio of world-class cutaneous neurodiagnostics products. This position will be responsible for developing and sustaining the required infrastructure to thrive in the ever-changing managed care environment and ensure timely and efficient enrollment with payers including managed care plans, Medicare, Medicaid, commercial plans and other programs. Responsibilities include but are not limited to supporting managed care contracting negotiations, operations and maintenance of the contract management database and contracting calendar. In addition, the Director will play a primary role in all financial analysis related to the development of new and existing contracts and be part of the Company's Pricing & Contracting (P&C) Committee. Job Responsibilities: Conduct managed care contracting related research and analysis, including developing compensation/reimbursement models and parameters consistent with guidance form the P&C Committee. Evaluate best-fit options for continued negotiations. Design statistical and financial reporting models to appropriately evaluate the financial and market share contribution of each payer. Prepare executive summaries and recommendations, and interface closely with CND's Finance & Strategy team. Investigate and resolve payer related payment and billing delays at the request of the VP, RCM. Ensure carved-out services are billed as appropriate and in accordance with procedural requirements of the contract. Monitor reimbursement and capitation requirements. Ensure that revenues from health plan/IPA/third-party contracts are optimized for CND's cutaneous neurodiagnostics products; renegotiate agreements as necessary, monitor incentive reimbursement, monitor value-based incentives/quality initiatives programs. Communicate with the organization all updates regarding new and existing contracts. Complete applications for ERA, EDI, and EFT. Help oversee and guide staff and consultants who serve as technical resource for key projects including CND teams and RCM end-users for database and/or interface requirements, specifications, and implementations. Coordinate monthly/quarterly payer meetings as needed to support CND in achieving continuous reimbursement and resolving specific payer issues. Establish and maintain relationships with State and Federal government agencies, health care associations regarding issues pertaining to managed care programs to maintain pertinent knowledge about the changing healthcare/managed care environment affecting the organization. Work with IT and other departments to coordinate utilization reporting process that monitors contract compliance. Ensure health plan compliance with all applicable laws and regulations as well as CND policies.

Prepare and present analytics and statistics that promote effective revenue maximization. Assist the VP, RCM with other duties and reports as needed. Knowledge, Skills & Experience: Minimum 5+ years' experience as a healthcare services and payer contracting leader for novel products and services; diagnostics industry experience highly preferred. 3-5 years of progressive experience in managed care or equivalent health care management. Ability to perform contract analysis/negotiation of healthcare managed care contracts leading to favorable reimbursement rates. Knowledge of Medicaid and commercial insurance practices Excellent written, verbal, and interpersonal communication skills are essential, and one must communicate technical concepts clearly to a diverse audience. Requires a high level of problem solving and analytics skills. Must be highly proficient in Excel and data analysis. Strong computer-based skills, specifically with Salesforce, Medisoft, and Microsoft programs. Education, Certifications and Licensures: BA or BS in Business Administration, Finance, Healthcare Administration 10+ years of experience in a similar leadership role may be substituted for educational requirement Other: This position is based in Scottsdale with flexibility for remote work and some travel to our headquarters located in Atlanta, GA (as determined and approved by the VP, Revenue Cycle Management). Open to considering candidates in Atlanta, GA, or other remote locations 15-20% out of state travel required

#J-18808-Ljbffr

  • Payer Contracts Manager

    4 weeks ago

    Atlanta, United States Unity Works Talent Full time

    About the job Payer Contracts Manager Position Details This role offers remote and hybrid options. Are you passionate about making a difference in people's lives through superior home healthcare? Look no further! Current Opportunities: As a key member of a healthcare contracting department, the Payer/Managed Care Contracts Manager is responsible for the...

  • Payer Contracts Manager

    16 hours ago

    Atlanta, United States Unity Works Staffing & Solutions Full time

    Job Description Job Description Position Details This role offers remote and hybrid options. Are you passionate about making a difference in people's lives through superior home healthcare? Look no further! Current Opportunities: As a key member of a healthcare contracting department, the Payer/Managed Care Contracts Manager is responsible for the...

  • Payer Contracts Manager

    3 weeks ago

    Atlanta, United States Unity Works Staffing & Solutions Full time

    Job DescriptionJob DescriptionPosition DetailsThis role offers remote and hybrid options. Are you passionate about making a difference in people's lives through superior home healthcare? Look no further! Current Opportunities: As a key member of a healthcare contracting department, the Payer/Managed Care Contracts Manager is responsible for the...

  • Director FP&A

    1 week ago

    Atlanta, United States LaSalle Network Full time

    LaSalle Network has partnered with a rapidly growing Digital Software company. As our client continues to innovate and drive excellence in their industry, they are seeking a highly motivated and strategic Director FP&A to join their finance team. This is a fully remote position, and they are looking for a leader who will play a pivotal role in shaping the...

  • Director of Network/IT Infrastructure

    3 days ago

    Atlanta, United States Piedmont Healthcare Full time

    JOB PURPOSE: Responsible for providing leadership and direction for service lines within the IS Technical Services teams. This position is responsible for the design, evaluation, project planning, implementation and support of Piedmont Healthcare infrastructure for the networking, server, and storage service lines. Primary focus/responsibility is to direct...

  • Director of Network/IT Infrastructure

    2 weeks ago

    Atlanta, United States Piedmont Healthcare Corporate Full time

    Description: JOB PURPOSE: Responsible for providing leadership and direction for service lines within the IS Technical Services teams. This position is responsible for the design, evaluation, project planning, implementation and support of Piedmont Healthcare infrastructure for the networking, server, and storage service lines. Primary focus/responsibility...

  • IT Director

    3 weeks ago

    Atlanta, United States In the Network LLC Full time

    Job DescriptionJob DescriptionJob Title: IT DirectorLocation: Atlanta, GAJob Type: Full-time, in office position. Hybrid may be considered.Introduction:We are seeking an experienced IT Director to oversee and enhance our global IT operations. The ideal candidate will lead our IT department, ensuring seamless integration and efficient collaboration between...

  • Director of IT

    5 days ago

    Atlanta, United States In the Network LLC Full time

    Job DescriptionJob DescriptionJob Title: Director of ITLocation: Atlanta, GAJob Type: Full-time, in office position. Hybrid may be considered.Introduction:We are seeking an experienced IT Director to oversee and enhance our global IT operations. The ideal candidate will lead our IT department, ensuring seamless integration and efficient collaboration between...

  • Sales Director

    7 days ago

    Atlanta, United States Food Management Search Full time

    Our client is a disruptor of services towards the legal & insurance industries. Formed out of demand, and expanded during today’s virtualization and technology, they are experiencing significant growth. As a privately held company with deep pockets they want someone who can work in a virtual environment with the ability to travel as needed. Due to growth,...

  • Neurosurgery Coder

    3 weeks ago

    Atlanta, United States LaSalle Network Full time

    LaSalle Network has partnered with a leading healthcare provider in their search for a Neurosurgery Coder. As a Neurosurgery Coder, you will play a vital role in ensuring accurate and compliant coding of neurosurgical procedures and services. The ideal candidate will have a minimum of 4 years of recent experience in neurosurgery facility and professional fee...

  • Neurosurgery Coder

    3 weeks ago

    Atlanta, United States LaSalle Network Full time

    LaSalle Network has partnered with a leading healthcare provider in their search for a Neurosurgery Coder. As a Neurosurgery Coder, you will play a vital role in ensuring accurate and compliant coding of neurosurgical procedures and services. The ideal candidate will have a minimum of 4 years of recent experience in neurosurgery facility and professional fee...

  • Global Network Manager

    2 days ago

    Atlanta, United States Tier4 Group Full time

    Global Network Manager / Senior Manager Network ServicesDirect Hire / Permanent PositionHybrid Onsite Pay: $125k + discretionary bonusOther benefits: matching 401k plus moreIndustry Leader!Overview: Looking for someone who has come up through the ranks as a Network Engineer, with global experience, and has managed network / data center projects as well as...

  • IT Director

    4 weeks ago

    Atlanta, United States City of East Point Georgia Full time

    This is highly responsible technical and administrative work that is responsible for evaluating, designing, and maintaining the complex computer and networking systems in the city. Work is performed under the general supervision of the City Manager. Director, IT, Information Technology, Automation, Operations, Systems

  • Global Network Manager

    7 hours ago

    Atlanta, United States Tier4 Group Full time

    Global Network Manager / Senior Manager Network ServicesDirect Hire / Permanent PositionHybrid OnsitePay: $125k + discretionary bonusOther benefits: matching 401k plus moreIndustry Leader!Overview: Looking for someone who has come up through the ranks as a Network Engineer, with global experience, and has managed network / data center projects as well as...

  • Sales Director

    6 days ago

    Atlanta, GA, United States Food Management Search Full time

    Our client is a disruptor of services towards the legal & insurance industries. Formed out of demand, and expanded during today’s virtualization and technology, they are experiencing significant growth. As a privately held company with deep pockets they want someone who can work in a virtual environment with the ability to travel as needed. Due to...

  • Director of Leadership Giving

    2 weeks ago

    Atlanta, United States Annual Giving Network Full time

    Holy Innocents’ Episcopal School (HIES) is seeking a Director of Leadership Giving. HIES is the largest Episcopal parish independent day school in the country, serving 1,400 students and offers a fully accredited college preparatory program for students ages three through 12th grade. Holy Innocents’ mission is to develop in students a love of learning,...

  • Global Network Manager

    5 days ago

    Atlanta, United States Tier4 Group Full time

    Global Network Manager / Senior Manager Network ServicesDirect Hire / Permanent PositionHybrid Onsite Pay: $125k + discretionary bonusOther benefits: matching 401k plus moreIndustry Leader!Overview: Looking for someone who has come up through the ranks as a Network Engineer, with global experience, and has managed network / data center projects as well as...

  • Global Network Manager

    5 days ago

    Atlanta, United States Tier4 Group Full time

    Global Network Manager / Senior Manager Network ServicesDirect Hire / Permanent PositionHybrid Onsite Pay: $125k + discretionary bonusOther benefits: matching 401k plus moreIndustry Leader!Overview: Looking for someone who has come up through the ranks as a Network Engineer, with global experience, and has managed network / data center projects as well as...

  • Data Network Engineering Manager

    1 week ago

    Atlanta, United States Bank of America Full time

    Job Description: Responsible for building and leading a team to deliver technology products and services that meet business outcomes. Ensures people development through coaching, mentoring, feedback, and hands-on career development. Develops a technology strategy and ensures technology solutions comply with applicable standards. This role advocates and...

  • Regional Sales Director

    3 days ago

    Atlanta, United States Academy Bus Full time

    Academy is seeking a highly motivated and creative individual to sell and market motorcoach charters for our Atlanta, Raleigh/Durham, and Charlotte markets. the Regional Sales Director is based in our Atlanta office and will oversee the sales teams in various locations throughout the region. Regional Sales Director Responsibilities: Responsible for...