Overview

The Director, Managed Care Contracting is responsible for utilizing business and industry expertise, accepts responsibility for all activities in the Managed Care department applying to and impacting WakeMed facilities' managed care contracts including budgeting, analysis, contract modeling, negotiation meetings and monitoring and reporting of payor contracts' compliance. Directs organizations efforts at building relationships with area managed care plans. Directly manages and develops a portfolio of managed care contracts. Directs contracting strategy for hospitals, Healthplexes, hospital outpatient departments, Home Health and Rehab divisions. Develops payment models for facility managed care contracts. Oversees facility what-if modeling analysis performed in STRATA modeling tool. Oversees the following noncontracting Managed Care responsibilities: hospital contract loading in EPIC, hospital payment variances, facility credentialing. Works with CFO, Vice President of Finance, Finance Directors and financial analysts to analyze feasibility of different payment methodologies/utilization patterns and the impact on WakeMed. Monitors market trends and competitive managed care products to develop strategy recommendations. Works with WakeMed's accountable care organization to coordinate contracting efforts and outcomes beneficial to WakeMed providers. When requested, interfaces with external and third party auditors; prepares and defends contract questions and challenges; maintains quality of work and creates value through knowledge and experience with governmental regulations and processes. Adheres to service and workforce excellence by maintaining knowledge of third-party regulations (CMS, NCDHHS, DOI, etc.) for all payors, including governmental and commercial payors. Oversees problem solving related to contract terms, payment promptness, payor-member issues, and physician-payor relations. Works closely with other Finance teams to ensure reported data is reliable. Plans and organizes activities for personnel to ensure deadlines and goals are met. Supervises and trains staff to improve and maintain the accuracy and timeliness of contacts.

Licensure

Certified Healthcare Financial Professional Or Certified Public Accountant Or Certified Revenue Cycle Representative Preferred
Education

Bachelor's Degree Business Administration Or Healthcare Management Or Accounting Required - With College Courses Finance Required - And Master's Degree Related Field Preferred
Experience

10 Years Managed Care Contracting Required - And 5 Years Healthcare - Multi-Hospital System Preferred