Head of Managed Care Agreements
2 weeks ago
Position Title: Director of Managed Care Contracting
Reports To: Senior Vice President
Employment Type: Full Time, Exempt
Compensation Range: $75,000 - $85,000
* Initial salary may vary based on geographical location and individual experience, adhering to state wage laws. Competitive compensation tailored to your expertise and location.
Role PurposeThe Director of Managed Care Contracting is crucial in formulating, executing, and overseeing the management of third-party payer agreements for Coronis Health clients. This position serves as a liaison between Coronis and its clients, as well as between clients and insurance providers, by crafting and articulating a comprehensive strategy for managed care contracting activities, rate negotiations, and the rollout of new payer agreements.
Key Responsibilities- Oversee and assess third-party payer agreements to ensure a cohesive strategic approach to managed care contracting for Coronis clients.
- Analyze relevant data to establish rates for negotiations on behalf of Coronis clients.
- Engage in negotiations for new contracts and renegotiate existing agreements to meet specified timelines.
- Assess payer rate proposals and modifications to client reimbursement structures.
- Utilize or develop models to aid in the evaluation of payer contracts.
- Review contracts and collaborate with insurance providers and clients to finalize terms, ensuring alignment with agreed-upon conditions before recommending client signatures.
- Terminate contracts as directed by clients when necessary.
- Maintain and update a comprehensive contract profile for each client, documenting all critical terms and conditions (e.g., reimbursement rates, renewal dates, filing limits, special rates, etc.).
- Conduct regular meetings with client managers and senior management to provide updates on the contracting status of relevant payers.
- Lead or facilitate internal operations to resolve payer-related issues, including underpayment of contractual rates.
- Initiate and conduct meetings with contracted payers to address operational and payment challenges, recommending adjustments to internal processes as needed.
- Bachelor's degree or equivalent experience in lieu of a degree.
- A minimum of 5 years of experience in multi-site and multi-state managed care contract negotiations and administration.
- Familiarity with the revenue cycle process, particularly in collections, payment posting, denial resolution, and other critical reimbursement areas, including payment accuracy in relation to contracts.
- Highly organized and detail-oriented with strong communication skills for drafting correspondence.
- Proficient in Microsoft Word and Excel.
Ability to sit, talk, and listen for extended periods throughout the workday; stand, walk, push/pull, bend, stoop, kneel, and reach occasionally. Frequent repetitive hand motions, including grasping and handling. Capability to read handwritten and typed documents on paper and/or computer screens.
The physical requirements outlined above represent the physical capabilities necessary for an employee to perform the essential functions of this role. Reasonable accommodations may be made to enable individuals with disabilities to fulfill these essential functions.
This description serves as a foundational guideline for fulfilling job requirements. Responsibilities, knowledge, skills, abilities, and working conditions may evolve as organizational needs change. Coronis Health is dedicated to fostering a diverse and inclusive workplace where all employees are treated equitably and with dignity. We are an equal-opportunity employer, offering equal opportunities to all applicants and employees, regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, or any other protected characteristic. We welcome and encourage applications from candidates of all backgrounds.
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