Director of Managed Care Services - Lancaster, United States - ANTELOPE VALLEY HEALTHCARE DISTRICT

ANTELOPE VALLEY HEALTHCARE DISTRICT
ANTELOPE VALLEY HEALTHCARE DISTRICT
Verified Company
Lancaster, United States

1 week ago

Mark Lane

Posted by:

Mark Lane

beBee recruiter
Description

Job Objective:


Under the direction of the Chief Financial Officer, the Director of Contracts assists with the negotiation; implementation, and monitoring of all managed care agreements, including contracts with health plans (HMOs/PPOs), medical groups, government agencies, and other third-party payors.


Essential Duties and Responsibilities:


  • Assists with negotiation and review of proposed agreements and contract renewals with HMOs, PPOs, Medical Groups, Government Agencies, and other thirdparty payors.
  • Conducts research prior to negotiations including analysis of historic utilization patterns and resource consumption; payment history; identification of administrative issues; and prioritizing opportunities for improvement.
  • Assists with the reviews proposed contract language to validate the contract is consistent with AVH Policy and to identify opportunities for improvement.
  • Prepares financial models to estimate the financial impact of contract proposals.
  • Helps to identify industry trends and changes to AVH service offerings that may require changes to payment structures (i.e. Add Trauma rates; exclusions for Aphaeresis, etc.)
  • Contract Management System & Data Reporting
  • Maintains contract management system with support from IT Department to calculate contractual allowances and expected reimbursement.
  • Maintains a shared folder on AVH Intra-Net with a summary of contract rates and terms.
  • Prepares adhoc reports for senior management and directors of other departments.
  • Monitors claim payment patterns to validate that actual reimbursement and actual referral volume are consistent with expectations and budget.
  • Prepares monthly and quarterly utilization and claim payment reports for senior management in accordance with AVH Policy.
  • Contract filing and tracking
  • Maintains logs and tracking systems to make sure contracts make it through the approval and signature process in a timely mariner after negotiations.
  • Maintains contract storage system to ensure that all managed care contracts and correspondence are properly filed and protected.

Non-Essential Duties:


  • Ensures that all necessary supplies for the department are ordered and tracked.
  • Participation as a Safety Officer and other work groups as requested.
  • Other duties as assigned, within skill sets and abilities

Knowledge, Skills and Abilities:


Knowledge

  • Working knowledge of Commercial, HMO, PPO, and Workers' Compensation reimbursement
  • Working knowledge of Managed Care contract language and interpretation
  • Working knowledge of Common Procedural Terminology (CPT) and ICD9/ICD10 Codes
  • Working knowledge of Microsoft Office
  • Knowledge of basic arithmetic

Skills

  • Knowledge of basic personal computers
  • Knowledge of the use of calculators
  • Proficient in the manipulation and analysis of large spreadsheets and databases
  • Proficient in the operation of scanners, copiers, and fax machines

Abilities

  • Ability to identify and industry trends and analyze opportunities and threats to hospital reimbursement.
  • Ability to make decisions and recommendations with limited or conflicting data
  • Ability to handle stress
  • Ability to manage a heavy caseload in an organized and efficient manner
  • Ability to recommend appropriate account adjustment and writeoffs
  • Ability to recognize potential accounts receivable related problems and offer solutions to management
  • Ability to maintain a working relationship with other departments within the organization
  • Ability to review all billing transactions for accuracy, discrepancies, and appropriate charges

Core Competencies:
All AVH employees will effectively demonstrate these behaviors:
Accountability

Action Oriented

Customer Focused

Compassion

Effective Communication

Teamwork

Ethics & Values

Integrity & Trust


Management Competencies:
All AVH management (Supervisor, Manager, Assistant Director,

and Director) will effectively demonstrate these behaviors:
Conflict Management

Problem Solving

Timely Decision Making

Process Management

Fairness to Direct Reports

Hiring & Staffing

Developing Direct Reports


Education and Experience:


Education

  • High School or equivalent
  • Bachelor's Degree in Business related field, preferred

Experience

  • Previous experience working with managed care contracts and hospital claim follow up, preferred
  • Minimum 2years managed care contracting experience

Required Licensure and/or Certifications:

-
None

AVH Conduct/Compliance Expectations:


  • Ability to adhere with AVH Leaves of Absence Policy
  • Ability to adhere with AVH Paid Time Off (PTO) Policy
  • Ability to adhere with AVH Recording of Hours Worked Policy
  • Ability to adhere to the department dress code
  • Ability to organize work and establish priorities
  • Ability to expand on own initiative in performance of duties
  • Skill and ability to follow the telephone etiquette/standards
  • Conforms to AVH Standards of Excellence
  • Ability to
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