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Head of Managed Care Agreements

2 months ago

Everett, Washington, United States Coronis Health Full time
Position Overview

Job Title: Director of Managed Care Contracting

Reports to: Senior Vice President

Status: Full Time, Exempt

Salary Range: $75,000 - $85,000

* Starting pay varies based on location and experience, in compliance with specific state wage regulations. Competitive rates tailored to your geography and expertise.

Role Summary

The Director of Managed Care Contracting is instrumental in the formulation, execution, and ongoing oversight 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 devising and articulating a comprehensive strategy for managed care contracting, rate negotiations, and the initiation of new payer agreements.

Key Responsibilities

  • Oversee and assess third-party payer agreements to ensure a unified strategic approach to managed care contracting for Coronis clients.
  • Analyze data to establish rates for negotiations on behalf of Coronis clients.
  • Negotiate new contracts and renegotiate existing agreements to meet established timelines.
  • Assess payer rate proposals and modifications to client reimbursement structures.
  • Utilize or develop models to facilitate payer contract assessments.
  • Review contracts and collaborate with insurance carriers and clients to finalize details, ensuring all terms align with prior agreements before recommending client approval.
  • Terminate contracts as directed by clients when necessary.
  • Maintain and update a comprehensive contract profile for each client, detailing 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 contracting status with relevant payers.
  • Guide internal operations to resolve payer-related issues, including underpayment of contractual rates.
  • Initiate and lead discussions with contracted payers to address operational and payment challenges, recommending adjustments to internal processes as needed.

Qualifications

  • Bachelor's degree or equivalent experience in lieu of a degree.
  • A minimum of 5 years' 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 to contract.
  • Strong organizational skills and attention to detail, with effective communication abilities for drafting correspondence.
  • Proficiency in Microsoft Word and Excel.

Physical Requirements

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 capabilities that must be met by an employee to perform the essential functions of this role. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

This description is intended to provide basic guidelines for meeting 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 environment where all employees are treated equitably and with respect. 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.