Director of Managed Care, Radiology
Less than 5 years experience • Managed Care & Health Insurance
We are an executive search firm who has been hired to identify a top talent, Director of Managed Care Radiology.
Skills/Capability Required as a Director of Managed Care, Radiology:
Excellent written and verbal skills; negotiation skills; good time management and organizational skills to be able to juggle multiple tasks simultaneously; strong professional and interpersonal skills to build and maintain relationships with payor physicians, other health care professionals and hospital management; ability to use software programs such as Excel spreadsheet, Word and data report writers; strong analytical, quantitative and financial skills especially for the development of health care service compensation proposals; able to work independently and as part of a team; able to set priorities and meet deadlines. Required - 40% - 60% travel.
Qualifications as a Director of Managed Care, Radiology:
- Required - Bachelor's Degree in related field.
- Preferred - Master's Degree in related field.
- Required - 5 years in health insurance, patient accounting and/or managed care including payor or The primary objective is to evaluate, negotiate, and secure agreements to new and existing contracts with health insurance benefit payors. Responsibilities include but are not limited to: managing the contract assignment process with acquisitions, leading contract negotiations, assisting in the resolution of contract payment issues, analyzing contract performance, and working on strategic and operational partnerships with payors. Responsible for providing independent support and direction to Regional Managed Care staff.
Major duties and responsibilities as a Director of Managed Care, Radiology:
- Conduct reviews to analyze reimbursement and language in payor contracts.
- Monitor current agreements for action on timely renegotiations.
- Evaluate and respond to new contract proposals from payors in a timely manner.
- Represent proposed contractlanguage changes to the payor according to departmental procedure on preferred terms and conditions.
- Prepare or work with analytical team to complete detailed reimbursement analysis including CPT code specific comparison and weighted average comparisons (i.e. to billed charges; to Medicare allowable; to old rates) using local and/or statewide coding frequency; analyze CPT code specific contract rates, and expected total payments based on negotiation proposals, old/new rates, and actual payments.
- Provide summary information on contract rates and key language to Corporate VP Managed Care, Regional staff, local Medical Directors, and other key colleagues; recommend strategy and tactics to secure optimal position in final agreements.
- When new contracts have been agreed, prepare signature memo, contract summary and notify appropriate departments.
- Coordinate with business development to develop revenue assumptions and complete due diligence for acquisitions.
- Respond in a timely manner to all correspondence and inquiries.
- Evaluate the managed care environment nationally, regionally and in local markets for the development of contracting strategy and tactics.
- Prepare periodic national and regional updates on the status of contracts in negotiation.
- Create and maintain contract records including original documents, correspondence, key documents in paper files, and the contract file database; provide timely and accurate data to Information Management and Contract Support.
- Understand company contracts with hospitals for medical directorships, stipends, unit management, or hospital privileges and implications for payor contracting and billed charges.
- Assess the value of physician organizations and understand the pros and cons of participation in IPAs, PHOs, and other physician contracting entities.
- Where applicable, coordinate among multiple service lines to secure optimal agreements for each specialty service.
- Work closely with Provider Enrollment to ensure correct par enrollment.
- Work closely with Patient Accounts to support optimal collections and act on overpayments/underpayments.
- Track Medicaid payments and program eligibility, and advocate for improved public policy, regulations, and program support.
- Work collaboratively with department administrative assistants to secure efficient, effective, and productive operational support.
- Corporate office duties:
- Manage negotiation, implementation and service of select national delegated credentialing agreements.
- Monitor any value based agreement (P4P, gain Share, Total Cost of Care, Capitation) contract currently in place. Perform annual analysis of the utilization to determine the fee-for-service equivalent and make recommendations for any improvements.
- Liaison to Corporate and Regional Patient Accounts for major questions and service issues on the 6 existing national agreements.
If you meet all the requirements for the Director of Managed Care, Radiology position, we want to hear from you!