Managed Care Regional Director

Role Overview

• Leads the implementation of managed care contracts and develops and maintains systems to effectively disseminate contract information for the assigned region.
• Manages the tracking, approval, administration, and post-implementation process of all managed care contracts throughout contract life cycle
• Achieve and maintain a full understanding of Medicaid and or Medicare pricing reimbursement and structure for both payers and providers
• Responsible for all aspects of managed care and direct revenue contract management including analysis interpretation, implementation, maintenance of the contract’s performance, and payer relations
• Responsible for coordination and communication between managed care and other interested party departments and leadership
• Responsible for developing new and existing relationships with medical and pharmacy plans to ensure competitive reimbursement rates and contract language attainable through the revenue cycle operations
• Oversight of payer credentialing
• Will assist with various payer prior authorization, eligibility, protocol, referrals, enrollment, billing issues, and education that relate to contracting
• Communicates with respective payers related to trends and compliance with contract parameters
• Consistently represents the company in a professional manner
• Maintain effective working relationships and cooperate with all personnel in the Company
• Adheres to the Company’s compliance requirements as stated in the policy and procedure manual and all other related policies

Requirements

• Bachelor’s Degree preferred or equivalent experience
• At least 2 years’ experience implementing contracted Third-Party programs in the healthcare industry
• Minimum two years in healthcare management manage care environment and administering contracts or equivalent experience
• Preferred experience in managing, analyzing, and reporting denials and appeals.