Director, Managed Care Compliance - Project Employee

Navigant Research   •  

Gardena, CA

Industry: Professional, Scientific & Technical Services

  •  

Not Specified years

Posted 164 days ago

This job is no longer available.

ID 8857

Practice Information

Navigant Cymetrix unites the strengths of four category-leading companies to address the complexities of today’s healthcare system.  We design, develop and implement integrated, patient-centered solutions for sustained improvements in performance and profitability, working collaboratively across a spectrum of customers that encompasses hospitals, health systems, physician practice groups and payers.

Responsibilities

The Director, Managed Care Compliance and Consulting is responsible for the overall direction and performance of the service line.  Direct responsibilities include development of operational performance, operational policies and procedures, establishment of internal controls and management tools, development and maintenance of capital and operating budgets.  The director is also accountable for the day to day operation of the contract analysis function and the underpayment review function within department which will entail accountability of client payer contractual pricing within proprietary databases.  This position is proficient in the subject matter of managed care payer contractual terms and rate methodologies with the ability to take a broad view of client payer contracts and strategically determine areas of perspective client revenue opportunities.  The Director will establish and maintain client relationships with Contract Administrators and other client points of contact.  The Director will also act as the primary and key contact for all department functions supporting other Navigant resources responsible for modular and total revenue cycle outsource solutions.

In addition, the Director will manage a supervisor of underpayment review and support staff charged with analyzing, loading and maintaining pricing of client payer contracts. The Director will work with the international Navigant management team to ensure appropriate performance by offshore resources

In addition, the Director will manage a supervisor of underpayment review and support staff charged with analyzing, loading and maintaining pricing of client payer contracts. The Director will work with the international Navigant management team to ensure appropriate performance by offshore resources.         

In addition, the Director will manage a supervisor of underpayment review and support staff charged with analyzing, loading and maintaining pricing of client payer contracts. The Director will work with the international Navigant management team to ensure appropriate performance by offshore resources.         

Essential Job Functions

  • Supervise the operation and support the new business development of the underpayment review function.
  • Direct the process of contract rate loading and associated maintenance.
  • Ensure contract terms are aligned appropriately for pricing.
  • Stays at the forefront of industry and regulatory changes to improve staff development and efficiencies.
  • Provide Client with contract recommendations with a focus on revenue improvement.
  • Ensure the achievement of service line financial goals (revenue, expense and margin).
  • Educate internal stakeholders on the proprietary software and the functions within the MCCC service line.
  • Educate staff on database logic that is used for loading contract terms to accurately price accounts.