Director Managed Care Contracting
Company: OU Health
Location: Oklahoma City
Posted on: January 24, 2023
Job Description:
Position Title:Director Managed Care
ContractingDepartment:Financial ServicesJob Description:Position
Title: Director Managed Care ContractingGeneral Description: The
Director, Managed Care Contracting has responsibility for
negotiating and managing managed care agreements on behalf of OU
Health hospitals and physicians and with third party payers,
including but not limited to Commercial, Medicare Advantage and
Medicaid managed care payers. Under the direction of the SVP,
Managed Care, the Director, Managed Care Contracting will analyze,
negotiate, and implement new and renegotiated managed care
agreements for the OU Health system, and develop payor strategies
to ensure optimal contracting and operational performance. The
Director, Managed Care Contracting will focus on increasing net
revenue through favorable contracts that exceed costs to provide
care, as well as on capturing maximum referral volume from each
executed contract wherever feasible. This position is also
responsible for managing and facilitating the relationship with
third party payers including Joint operating Committees (JOCs).
This position will also exemplify the OU Health mission, vision and
values and acts in accordance with OU Health policies and
procedures.Essential Responsibilities:Responsibilities listed in
this section are core to the position. Inability to perform these
responsibilities with or without an accommodation may result in
disqualification from the position.
- Negotiate and manage all managed care contracts with third
party payers in consultation with OU Health key stakeholders
- Supervise, coach and mentor Manager, Managed Care
Contracting
- Build and maintain positive ongoing relationships with all
third- party payers with the objective of maximizing market share
and revenues for OU Health hospitals and physicians.
- Work closely with SVP, Managed Care and senior leadership to
devise payer strategies that align with organizational goals
including market access and financial strength. This includes
evaluation and initiation of new managed care contract
opportunities, business models and payers' relationships.
- Advance organization's contracting and reimbursement strategy
through optimization of existing contracts and development of new
reimbursement models and innovation alternative payment models
(APM)
- Negotiate key legal terms working in conjunction with Director,
Managed Care Analytics, when needed, to develop financial models to
analyze payer proposals. Assess risk exposure, potential upside and
downside opportunities.
- Coordinate feedback and approval of contracts including
financial risks and rewards from OU Health stakeholders.
- Negotiate contract language and performance terms. This
includes legal, compliance, quality measures, reporting and data
exchange requirements.
- Lead implementation and coordination of new contracts
- Establish, facilitate and participate in Payer joint operating
committee (JOC) meetings.
- Work closely with support departments to develop, communicate
and disseminate orientation educational materials to inform and
educate key stakeholders regarding contract and performance terms,
reporting tools and resources and market trends.
- Develop and maintain contract summaries including performance
targets and measures matrix, timelines, contract requirements and
deadlines.
- Owner of Contract Information System and other tools.
- Monitor and manage payer compliance issues including rosters,
assignment, reports, delivery dates, fees, audits.
- Monitor and analyze changes in payer programs and policies that
may affect contract performance and initiate negotiations as
warranted.
- Work with Manager, Managed Care to coordinate any
credentialing/provider enrollment or request for information
(RFI's) requirements for new contract and initiatives.
(renewals)
- Revenue Cycle support including negotiation of claims
settlements and single case agreements (SCAs)
- Participate in and report to various governing bodies including
the OU Health Finance and Audit committee; support for these
meetings and assist with contract material preparation and
presentation.
- Create strategic alliances with internal and external groups to
maximize payer relations and contract performance.
- Supervise Manager, Managed Care Contracting Manager. Set
objectives, review performance, conduct staff professional
development, and provide guidance in accordance with department
objectives, policies, and procedures. Facilitate staff recruitment,
retention, and onboarding/orientation.General Responsibilities:
- Performs other duties as assignedMinimum
Qualifications:Education: MBA, MHA or related Master's Degreein
Business, Finance, Health Care, Economics or related field is
required.
- Experience: 5 - 7 years of professional experience within an
Academic Medical Center, Multi-hospital Health System or Managed
Care Organization (MCO) company, with demonstrated experience in
healthcare analytics and medical economic modeling. Direct
experience leading the negotiations and management of complex
managed care contracts.License(s)/Certification(s)/Registration(s)
Required: None.Knowledge, Skills and Abilities:
- Strong knowledge of hospital and physician reimbursement
methodologies (i.e. DRG, per diem, fee schedule, APC).
- Working knowledge of billing/coding terminology (i.e. ICD-10,
CPT, Revenue codes).
- Procedural knowledge of hospital and physician practice
accounts receivable management.
- Strong industry knowledge of population health management
activities, fee-for-service delivery models and payment
innovation.
- Strong financial knowledge base related to all managed care
reimbursement methodologies including the various fee-for-service
structures and risk-based structures such as capitation, shared
savings and alternative payment models.
- Ability to think critically and strategically, understand
complex concepts and quantitative analyses, synthesis information
and make correct judgments.
- Strong written and verbal communication skills.
- Strong analytical and financial skills.
- Adapts well to rapid change and multiple, demanding
priorities.
- Focuses on team success and promotes collaboration efforts with
others.
- Excellent time and project management skills.
- Ability to network internally and externally to build
relationships, facilitate discussion and resolution.
- Microsoft Office Suite advanced proficiency, particularly MS
Excel, Access and PowerPoint.
Current OU Health Employees - Please click HERE to login.OU Health
is an equal opportunity employer. We offer a comprehensive benefits
package, including PTO, 401(k), medical and dental plans, and many
more. We know that a total benefits and compensation package,
designed to meet your specific needs both inside and outside of the
work environment, create peace of mind for you and your
family.
Keywords: OU Health, Oklahoma City , Director Managed Care Contracting, Executive , Oklahoma City, Oklahoma
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