Corp Director of Managed Care

Cornerstone Healthcare Group   •  

Dallas, TX

Industry: Healthcare

  •  

Not Specified years

Posted 53 days ago

Job Description

About Us

Cornerstone Healthcare Group, based in Dallas, Texas, was founded in 1990 and provides excellent healthcare services to our patients, residents and their families.

We pride ourselves on our quality of care, responsive service, and commitment to excellence. We treat each employee, patient and resident like we would a member of our own family, and measure our success by the direct impact we have on improving the quality of life for our employees, patients and residents.

The Corporate Director of Managed Care assists the Vice President of Managed Care as requested in establishing and implementing Corporate-wide managed care strategies and tactics. Key aspects of this responsibility include:

  • A mechanism for determining the viability of a given payor agreement;
  • Use of an electronic application to;
    • Facilitate communication among key internal and external stakeholders,
    • Archive documents;
    • Administer managed care agreements
  • The negotiation/re-negotiation of payor agreements;
  • The communication of performance data so as to stimulate negotiating interest and referrals from the payor.

The incumbent is a seasoned veteran in the field of managed care and is able to interact in a professional and intellectual fashion with senior management at Cornerstone, with each Cornerstone hospital, as well as with senior managers throughout the health care industry.

More specifically and upon request and as assigned, the Corporate Director of Managed Care:

  • Assists in the development of an annual managed care strategic plan and supports its rationale and execution.
  • Assists in an annual assessment as to Plan success.
  • Negotiates and re-negotiates managed care agreements according to established criteria.
  • Negotiates single-case agreements.
  • Serves as a direct resource for Cornerstone Hospital staff, encouraging them in their efforts to stimulate
  • referrals, assisting them with out-of-network conversions and payor softening initiatives.
  • Develops and maintains effective working relationships with managed care organizations and as necessary, referral and Cornerstone hospital physician leadership.
  • Presents selected performance data to payors in an effort to demonstrate Cornerstone’s value to the payor and to stimulate payor-driven referrals.
  • Validates and where indicated, coordinates post-payment audits.
  • Assists the Central Billing Office with payment-related questions and resolution.
  • Assists in revenue validation routines.
  • Performs other duties as assigned.

Technical Expertise

  • Knowledge of basic computerized word-processing, spreadsheet and e-communications required.
  • Knowledge of hospital billing and claims adjudication systems preferred.
  • Familiarity with diagnosis, billing and reimbursement schemes such as ICD-9-CM, RBRVS, CPT, UB-92 and HCFA preferred.