As Director of Health Plans, the role will oversee payor strategy, contracting and management at a regional level for both existing and future products. This individual will leverage their own experience and relationships to accomplish company objectives. The scope entails the identification and development of new payors, as well as the continued development and deepening of service relationships with existing payor clients. They will be responsible for monitoring and managing ongoing growth in revenue and profitability.
- Uses resources available such as market databases and Progenity financial reporting to identify and prioritize prospects which enhance the regional territory.
- Identifies payor financial trends and manage stabilization, facilitating discussion with payor and billing.
- Identifies depth & maturity of existing client services relationships and develop plans to improve over time.
- Develops direct relationships with sales management, operations and billing. Establish yourself as a market leader that can help identify and fix challenges.
- Seeks opportunities for new patient volumes through payor initiatives.
- Maintains a mechanism for effective communication of relevant managed care-related developments across the industry.
- Builds and oversees all relationships with our health plan customers.
- Participates in activities which result in improved contract performance, which include performing payor analysis and communicating with all Revenue Cycle teams.
- Prepares reports, such as payor comparisons or regarding specific payor contract information.
- Facilitates the resolution of problem payer issues utilizing personal contacts, negotiations and problem-solving skills.
- Manages contracting, including developing negotiation strategies, gathering data for negotiations, and participating in negotiations to achieve company’s objectives.
- Serves as the primary interface with our contract account management company.
- Acts as the Managed Care and reimbursement lead for company’s sales and marketing teams.
- Works with customers to facilitate streamlined reimbursement within the practice.
- Facilitates communication, implementation and maintenance of managed care policies, procedures and objectives.
- Provides Health Plan information and data to management and sales to ensure overall marketing effectiveness.
- Participates in strategy development for the team and lead Health Plan strategy in company meetings.
This list of duties and responsibilities is not all inclusive and may be expanded to include other duties and responsibilities, as deemed necessary.
Bachelor’s degree in Business or related field
- Master’s degree preferred
- 7+ Years of experience in account management and healthcare sales
- Experience with CPT-Code reimbursement
- Previous experience with independent home office work and travel
- Previous experience with bringing new products to healthcare market
- Presentation skills
- Previous contract review, negotiation
- Knowledge of CMS, and third-party payor requirements, prior authorizations, claims adjudication, medical policy review.
- Proficient in working with Microsoft Office, specifically MS Excel and Power Point.
- Must be able to handle a wide work variety and work in a fast-paced environment.
- Must be a detail-oriented, organized, self-starter, and have an ability to prioritize workload.
- Ability to analyse and interpret data and solve practical problems.