Director, Payor Relations & Regulatory Affairs
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Job Location:
Livermore, CA - USA
Monthly Salary:
$ 172000 - 344000
Posted on:
5 hours ago
Vacancies:
1 Vacancy
Job Summary
JOB DESCRIPTION:
Director Payor Relations & Regulatory Affairs
The Opportunity
Acelis Connected Healths (ACH) DME & IDTF businesses operate across all states in the US with several hundred payor plans to serve its 80000 patients on service. This Director Payor Relations and Regulatory Affairs will be accountable to develop strategies and drive ongoing activities that maintain and expand payor coverage while ensuring ACH remains compliant standards required by The Joint Commission state agencies and CMS (Medicare/Medicaid). These activities include leading the development implementation and monitoring of processes related to commercial payor contracting state licensing and CMS enrollments. These processes span across all lines of business at ACH.
What Youll Work On
The following reflects essential functions for this job but does not restrict the tasks that may be assigned. Management may assign or reassign duties and responsibilities to this job at any time due to reasonable accommodation or other reasons.
- Directly hires develops and drives engagement for team members across Payor Relations and Regulatory departments
- Oversees essential activities and process improvement related to commercial payor contracting across all lines of business; specific contracting activities include but are not limited to:
- Contract redlining
- Contract implementation
- Contract monitoring
- Contract management including initial & ongoing credentialing
- Payor escalation management including payment discrepancy resolution
- Oversees essential activities and process improvement related to regulatory affairs for ACH; specific contracting activities include but are not limited to:
- State licensing
- Medicare and Medicaid enrollments
- The Joint Commission Accreditation
- Maintains governance processes to ensure alignment to contracting and regulatory business expectations with cross-functional stakeholders including: finance commercial operations revenue cycle management legal and the office of ethics & compliance
- Develops maintains and presents to leadership the KPIs/metrics related to areas of responsibility
- Contributes to business strategies related to commercial contracting payor management and regulatory compliance; examples include: patient access pricing payor management Medicaid advocacy state licensing applications and accreditations.
Required Qualifications
- Bachelors Degree in a business discipline
- 10 years relevant experience in payor contracting at a healthcare provider payor or network
- 5 years directly interacting with regulatory agencies
- Demonstrated ability to develop improve and monitor commercial contracting processes
- Ability to work independently and managing competing priorities routinely.
Preferred Qualifications
- Masters Degree in related field
- 5 years experience in payor contracting within the DME/IDTF provider space
- 5 years experience working directly with CMS (Medicare/Medicaid) The Joint Commission and state licensing agencies
Participants who complete a short wellness assessment qualify for FREE coverage in our HIP PPO medical plan. Free coverage applies in the next calendar year.
Learn more about our health and wellness benefits which provide the security to help you and your family live full lives:
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The base pay for this position is
$172000.00 $344000.00In specific locations the pay range may vary from the range posted.
JOB FAMILY:
Regulatory Operations
DIVISION:
HF Heart Failure
LOCATION:
United States > Livermore : 6465 National Drive
ADDITIONAL LOCATIONS:
WORK SHIFT:
Standard
TRAVEL:
Not specified
MEDICAL SURVEILLANCE:
Not Applicable
SIGNIFICANT WORK ACTIVITIES:
Keyboard use (greater or equal to 50% of the workday)Abbott is an Equal Opportunity Employer of Minorities/Women/Individuals with Disabilities/Protected Veterans.
EEO is the Law link - English: EEO is the Law link - Espanol: Experience:
Director
Key Skills
- Proofreading
- Adobe Acrobat
- FDA Regulations
- Manufacturing & Controls
- Biotechnology
- Clinical Trials
- Research & Development
- GLP
- cGMP
- Product Development
- Chemistry
- Writing Skills
About Company
WHO WE ARE CREATING LIFE-CHANGING TECHNOLOGY From removing the regular pain of fingersticks as people manage their diabetes to connecting patients to doctors with real-time information monitoring their hearts, from easing chronic pain and movement disorders to testing half the world’s ... View more
