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Director of Managed Care - Albuquerque, United States - HME Specialists LLC
Description
Job DescriptionJob Description
About the job
HME Specialists is a fast growing primary player in NM providing Durable Medical Equipment, Home Infusion and LTC/Hospice services
The Director of Managed Care & Contracting will oversee strategy and development for all Managed Care Services and Contracting for the LTC and New Vista lines of business.
The Corporate Director is responsible for full managed care contract life-cycle support, including new business and revenue development through continued clinical integration and market expansion.
Job duties & responsibilitiesDevelop, negotiate, and implement new and ongoing payor strategies, models, and partnerships that support HME revenue and margin growth
Proactively identify and engage target payors who are candidates for innovative partnership that maximize HME Specialists ability to provide services to all patients regardless of insurance
Deliver improved payor satisfaction through the execution of strategic programs and assisting in reporting on patient care to managed care partners.
Lead and maintain credentialing, re-recredentialing, reimbursement, and contracted entities updatesAssist with claims escalation processes with payer partners
Leads and assists with RFP's.
Support and educate Case Management
Serves as a subject matter expert on contract and reimbursement-related issues impacting our industry and healthcare industries, particularly with a managed care and commercial reimbursement focus.
Knowledge/Skills/AbilitiesThe qualified candidate will have extensive knowledge and relevant work experience in the Managed Care/insurance sectors including network
planning/development,
contract negotiations, etc.
Proficient knowledge of medical contracting methodologies and claims
pricing/reimbursement
strategies
This position reports to the VP of Sales and Business Development.
Experience
Experience in Managed Care contracting for a multi-site Ancillary Healthcare Provider desired.
2 years of healthcare contracting experience required.
Bachelors degree preferred
Experience with Medicare Licensure preferred.
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