The Assistant Director of Managed Care is responsible for assisting in the planning, analysis, negotiation, and implementation effort for new and renegotiated contracts for assigned Inpatient Rehab hospital and Outpatient clinic portfolio. Serve as corporate liaison for Operations, Admission department leaders as well as the Central Billing Office. This position will assist in the efforts of increasing net revenue through favorable contracts that exceed our costs to provide care as well as on capturing maximum referral volume from each executed contract and increasing out of network volume wherever feasible. Support contracting efforts for new hospital and outpatient clinics integration as well as consolidations/closures.
- Analyze, negotiate, and implement new and renegotiated contracts for assigned hospital and clinics. Assist with the development and execution of payor strategies to ensure optimal contracting and operational performance.
- Provide support for rate and payment methodologies, contract language, as well as following all internal controls for contract review and administration, approval, and signature.
- Assist with the implementation of new contracts/renegotiations/physician agreements/medical group agreements.
- Oversee credentialing/re-credentialing, and assist with billing/reimbursement issues.
- Ensure COLA’s are administered in accordance to contract terms.
- Complete and execute Single Case Agreements and Letters of Agreement.
- Assist as Contracting liaison for Corporate Operations, key support functions, CEO’s, Business Development, Operations and Finance.
- Assist with the implementation of new contract roll-outs and post roll-out analysis.
- Complete Rate per patient day, and Rate per patient visit trend analysis, and activity volume measurements for existing contracts.
- Provide support to finance and legal for decision support and contract performance.
- Update all activity and summary documents for quarterly and annual reporting.
- Participate in key payor meetings acting as lead liaison and tracking issues.
- Hospital, payor relations, admissions and case management support.
- Update Contract Information System and other library tools.
- Develop and maintain positive payor relations, identify and address issues.
- Respond to inquiries and issues for new and renegotiated contracts.
- Regularly review insurance verifications at request of hospital staff.
- Coordinate information and analysis requests from corporate case management.
- Ensure hospitals maximize utilization of contracts.
- Obtain payor contacts for new contracts to establish initial and ongoing meetings.
- Attend hospital AR/Contract calls, disseminate market trend findings and opportunities, track post meeting action items and provide status updates.
- Assist with rate verification tracking tool for Inpatient Rehab and Outpatient payors.
- Coordinate meetings with hospitals to resolve payor and/or volume issues, market consolidations, joint venture-related matters, and closures as requested.
- Business Development and Integration.
- Oversee contract and credentialing implementation for new hospital openings/closures/mergers, JV’s, and acquisitions.
- Follow the JV and Acquisition integration processes and procedures.
- Coordinate the Go-Live contracting payor status matrix updates with the Central Business Office and Operations team.
- Bachelor’s degree or higher preferred or equivalent work experience.
- 2-3 years demonstrated experience in a managed care setting, hospital setting, preferably working in contracting or provider relations arenas
- Required Abilities
- Ability to develop or refine internal and external processes to ensure optimal efficiency and ease of administration of new and existing contracts and to implement changes
- Strong project management skills. Strong attention to details, timelines and follow-through
- Collaborative and positive manner
- Ability to interact and work with all levels in the organization
- Creative problem solving skills. Ability to anticipate needs and be proactive in planning and execution. Flexible and adaptable to change
- Strong verbal and written communication skills
- Ability to work independently and with minimal instructions and supervision. Ability to prioritize and complete multiple projects in the most effective/results oriented order
- Required to be proficient in Windows-based office technologies (Word, Excel, ACCESS, Power Point)
- Strong medical terminology and knowledge of the managed care/provider business environment
Select Medical is committed to having a workforce that reflects diversity at all levels and is an equal opportunity employer. Qualified applicants are considered for employment, and employees are treated during employment without regard to race, color, religion, national origin, citizenship, age, sex, sexual orientation, gender identity, marital status, ancestry, physical or mental disability, veteran status, or any other characteristic protected under applicable law.
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