Director, Contract Administration, Managed Care
JOB DESCRIPTION:
The primary responsibility of the Director, Contract Administration, Managed Care is to independently evaluate, negotiate, and secure agreement to new and existing contracts with third party payors, including commercial health plans, managed Medicare health plans, managed Medicaid health plans and county/hospital district entities. Responsibilities include, but are not limited to; leading and negotiating third party payor negotiations, reviewing and reaching agreement with payors on contract language, establishing contract performance reports, assisting in collection efforts, and assistance with public policy initiatives.
ESSENTIAL JOB FUNCTIONS:
- Independently negotiates contractual terms and reimbursement arrangements for health system and faculty group practice.
- Independently prepares and presents strategic, financial and operational proposals regarding payor agreements.
- Ensures contractual compliance with federal, state, and institutional requirements.
- Supervises the coordination and completion of information for clients.
- Mediates managed care issues between managed care organizations, hospital and clinic personnel.
- Works with County Affairs office on strategic considerations and operational concerns related to county and hospital district operational concerns.
- Tracks and evaluates managed care as it relates to the local market changes.
- Assists with strategic planning and business development.
- Adheres to internal controls as established by department.
- Adheres to internal controls and reporting structure.
- Performs related duties as required.
MINIMUM QUALIFICATIONS:
- Bachelor’s degree or equivalent and 5+ years related experience
- Significant experience negotiating managed care contracts with third party payors;
- Knowledge of physician professional service compensation models issues and experience with fee schedule, case rate, per diem, and capitation reimbursement; familiar with patient accounting tasks including billing, collections, and reimbursement analysis
KNOWLEDGE / SKILLS / ABILITIES:
- Excellent written and verbal skills; negotiation skills, computer proficiency (Excel and various software programs, data report writers.)
- Strong interpersonal and verbal and written communication skills.
- Strong analytical and quantitative skills for the development of reimbursement proposals.
EQUAL EMPLOYMENT OPPORTUNITY:
UTMB Health strives to provide equal opportunity employment without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, genetic information, disability, veteran status, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. As a VEVRAA Federal Contractor, UTMB Health takes affirmative action to hire and advance women, minorities, protected veterans and individuals with disabilities.
