Sr. Director of Managed Care Contracting

*The position is onsite in Roanoke, VA* The Senior Director of Managed Care Contracting serves as a leader in organization management of payer contracting including portfolio, performance, execution, coordination and implementation of Value Based and Fee-For-Service arrangements for facility, physician, and ancillary agreements.
You will assist with price modeling, hospital contract modeling, performance monitoring and auditing.
Additionally you will facilitate the implementation of new processes & programs on a cross-department organizational structure.
Duties may include but not limited: Works in close cooperation with Vice President to ensure current contracts are managed well while assisting in developing innovative future contracts and relationships with payers and employers.
Responsible for analysis and contracting of risk and non-risk contractual arrangements (including reimbursement and contractual language) between Carilion Clinic, owned and affiliated hospitals, ancillaries, Physicians (medical groups) and third-party payers for the provision of health care services to member/patients.
Payers include Commercial Insurance, Medicare Managed Care, Medicaid Managed Care, Third Party Administrators, Workers’ Compensation and Employers under Direct Contracts.
Executes and monitors a payer performance and accountability structure which will administer, track and resolve contractual performance and business activity supporting the ability to maximize organization revenue, growth and retention.
Achievement of annual and periodic goals for significant statistical indicators of revenue cycle performance including the management of hospital write-offs due to no authorization, medical necessity denials, or other reasons for writing-off any portion of an account.
Oversee the Contract Management area to ensure Carilion is obtaining maximum reimbursement allowed by payer.
Works to negotiate and implement delegated credentialling contracts in order to improve timeliness of provider enrollment with payer.
Will be Carilion's representative on the VHHA Payer Advisory Council to assist in addressing payer concerns at a state level.
Supports development, implementation, and compliance of Managed Care policies and procedures necessary to support operations.
Supervises staff in contract management, contract compliance, modeling and financial analysis.
Designs, establishes, and maintains an organizational structure and staffing to effectively accomplish the organization's goals and objectives: recruits, employs, trains and evaluates staff.
What We Require: Education: Bachelor’s Degree in accounting, finance or business administration.
Master’s degree in business administration or related field desirable.
Experience: Seven years experience in healthcare finance, accounting or financial planning Licensure/Certifications/Registration: CPA desirable About Carilion This is Carilion Clinic .
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An organization where innovation happens, collaboration is expected and ideas are valued.
A not-for-profit, mission-driven health system built on progress and partnerships.
A courageous team that is always learning, never discouraged and forever curious.
Headquartered in Roanoke, Va.
, you will find a robust system of award winning hospitals, Level 1 and 3 trauma centers, Level 3 NICU, Institute of Orthopedics and Neurosciences, multi-specialty physician practices, and The Virginia Tech Carilion School of Medicine and Research Institute.
Carilion is where you can make your own path, make new discoveries and, most importantly, make a difference.
Here, in a place where the air is clean, people are kind and life is good.
Make your tomorrow with us.
Requisition Number: 144720 Employment Status: Full time Location: CASB - Carilion Administrative Services Building Shift: Day Shift Details: Mon-Friday Recruiter: MARK A MISKOVIC Recruiter Phone: Recruiter Email: mamiskovic@carilionclinic.
org For more information, contact the HR Service Center at 1-800-599-2537.
Equal Opportunity Employer Minorities/Females/Protected Veterans/Individuals with Disabilities/Sexual Orientation/Gender Identity Carilion Clinic is a drug-free workplace.