Job details
Job type full-time
Full job description
Full time position remote / telework position position summary: the director, managed care contracting will play a vital role in developing,
Implementing, and ongoing management/monitoring of managed care contractsIn this highly visible position, the director, managed care contracting will represent grs to both internal and external customers by developing and communicating an overall strategy for managed care contract activities, rate negotiations, and implementation of new contractsResponsibilities:
Develops and administers managed care contracts in conjunction with senior management consistent with grs strategic approach to managed care payer contracting.
Works with stakeholders across the organization, including finance, revenue cycle, and operations, to ensure open communication and accessible information for all areas.
Evaluates rate proposals and changes to reimbursement.
Is a primary resource for the implementation of contract management software.
Identifies or creates tools, financial modeling systems, or other resources to assist with payor contract evaluations.
Assists internal customers with the resolution of payer issuesInitiates and leads meetings with contracted payers to address operational and/or payment issues and recommends changes to internal processes as needed.
Establishes and maintains positive working relationships with internal and external customers to improve quality outcomes while optimizing reimbursement or lowering costs.
Negotiates and administers single case agreements.
Chairs quarterly trend report calls and disseminates trend findings/opportunities.
Interprets information in payor provider manuals, newsletters, and bulletins and communicates such policy or procedure to applicable grs team members.
Responsible for the timely renewal of all payer contracts to ensure there is no delay in reimbursements.
Gathers and analyzes data on insurance companies and managed care providers to use in the development of pricing strategies.
Evaluates that the company has all necessary contracts required to increase referrals and admissions.
