Director of Billing and Managed Care in Atlanta, GA

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Industry:

Pharmaceuticals & Biotech   •  

5 - 7 years

Posted 7 weeks ago

Eurofins is searching for Director of Billing and Managed Care. Direct all 3rd party, governmental, private and institutional billing functions and the correlating financial analysis teams. Works directly with President on managed care strategy, negotiation, pricing, and all supporting functions. Manages the billing information, billing system, financial analysis, and managed care information.

Director of Billing and Managed Care responsibilities include, but are not limited to, the following :

· Oversees billing department and supporting functions and vendors.

· Oversees and participates in the development, negotiation, implementation, monitoring and management of all managed care agreements. Assist in the developments of policies and procedures to adhere to the contractual agreements.

· Evaluates and recommends financial parameters and reimbursement methodologies.

· Implements new managed care programs in conjunction with leadership team. Keeps staff apprised of developments in the managed care marketplace.

· Directs and participates in financial analysis of revenue projections based on contractual rates with payers, adverse trends, terms and appropriate recommendations or conclusions.

· Analyze and monitor financial aspects of existing managed care contracts. Utilize analysis for feedback on contract renewals, renegotiations or termination. Make recommendations regarding participation or non-participation with new or existing agreements.

· Facilitates promotion of departmental programs to provider networks.

· Develop and audit payer fee schedules based on negotiated reimbursement rates by contract and/or product line.

· Maintain and distribute participation information by payer by network product for all signed contracts, contracts under-negotiation, or plans not being negotiated.

· Responsible for reviewing managed care legal contract language and negotiating language to meet agreed to parameters with legal counsel to lessen risk and improve operational efficiencies. Strategic planning accountability for other reimbursement & profitability endeavors with subcontract arrangements, government programs, pay for performance initiatives.

· Assembles information and prepares materials for presentation to committees, administrators and managed care networks. Liaison with laboratories, other affiliated organizations and managed care organizations regarding issues pertaining to managed care. Initiate contact with Managed Care Plans to begin negotiation/re-negotiation process. Catalog and organize contracts along with helping maintain contracts data base and maintaining Managed Care data base. Work and manage Data Analyst to establish negotiating position and work with other Revenue Cycle departments to assure contract compliance. Develop strategies to link payment to performance and quality.

· Perform special projects as assigned by the President.

The ideal candidate would possess :

· Strong computer, scientific, and organizational skills

· Excellent communication (oral and written) and attention to detail

· Ability to work independently and as part of a team, self-motivation, adaptability, and a positive attitude

· Ability to learn new techniques, perform multiple tasks simultaneously, keep accurate records, follow instructions, and comply with company policies

Basic Minimum Qualifications :

· Bachelor's degree in a related field is required.

· Seven years billing, health care finance, or managed care experience required

· Authorization to work in the United States indefinitely without restriction or sponsorship