Director of Managed Care and Contracting Onsite

Genesis10 is currently seeking a Director of Managed Care and Contracting - Onsite for a direct hire position with a Healthcare Organization located in Staten Island NY. This position is fully onsite.

Compensation: $160000 - $180000 per year W2 based on qualifications

Position Overview:
This role oversees the managed care operations ensuring effective contract management financial performance and quality patient care. The Director will be pivotal in managing relationships with insurance providers coordinating care strategies and optimizing reimbursement processes to support the organizations strategic goals and maintain a competitive edge.

Key Responsibilities:

• Perform full life-cycle Contract Management for a portfolio of managed care contracts
• Develop administrative and technical contracting strategies through development negotiation implementation of terms and monitoring contractual agreements on behalf of our clients Health Network
• Review interpret analyze manage negotiate complex agreements resolve contractual issues and ensure adherence to all contract language financial guidelines and parameters
• Ensure compliance with contract terms and conditions
• Monitor and analyze contract performance addressing any issues or discrepancies
• Develop and maintain processes to provide timely notification of critical contract events (e.g. renewals termination and due dates contained within the agreements)
• Develop and implement strategies to maximize reimbursement and minimize denials
• Monitor financial performance including budgeting forecasting and variance analysis
• Collaborate with the finance department to ensure accurate billing and coding practices
• Track and maintain financial performance and status for all contracts to monitor and coordinate financial analysis of payer contract performance and modeling projections
• Provide direction and supervision to assigned department staff in areas of contracting contract management and provider relations
• Assist in producing and disseminating contract information to all relevant departments identify and resolve problems with contracts regarding billing claims payment scheduling registration credentialing service development care management and noncompliance
• Lead and manage the managed care department including hiring training and performance evaluation of staff
• Develop and implement policies and procedures to streamline managed care operations
• Coordinate with clinical and administrative departments to ensure seamless patient care delivery
• Support the entire contract process and closely collaborates with internal departments to ensure staff are informed of new contracts changes to existing contracts and updates to the medical and billing policies of the payers
• Ensure compliance with all relevant regulations standards and guidelines (e.g. CMS state regulations)
• Implement quality improvement initiatives to enhance patient care and operational efficiency
• Serve as the primary liaison between the hospital and MCOs insurance companies and other payers
• Foster positive relationships to enhance collaboration and problem-solving
• Represent the hospital in managed care meetings and negotiations
• Act as a liaison with Patient Financial Services physician offices and health plans to resolve contractual issues and ensure compliance with negotiated contractual terms
• Develop and execute strategic plans to improve managed care operations and support the hospitals overall goals
• Stay abreast of industry trends and best practices implementing changes as needed
• Participate in strategic planning and decision-making processes at the executive level

Primary Requirements:

• Bachelors degree in healthcare administration Business Administration or a related field (Masters degree preferred)
• 5 years contracting experience with hospital clinic physician and or health system required
• 3 years experience with medical insurance company MSO IPA TPA preferred
• Strong knowledge of managed care principles healthcare regulations and reimbursement methodologies
• Excellent negotiation communication and interpersonal skills
• Proven ability to analyze financial data and develop strategic plans
• Leadership skills with a track record of building and managing effective teams
• Proficiency in healthcare management software and Microsoft Office Suite

Only candidates available and ready to work directly as Genesis10 employees will be considered for this position.

If you have the described qualifications and are interested in this exciting opportunity please apply!

Ranked a Top Staffing Firm in the U.S. by Staffing Industry Analysts for six consecutive years Genesis10 puts thousands of consultants and employees to work across the United States every year in contract contract-for-hire and permanent placement roles. With more than 300 active clients Genesis10 provides access to many of the Fortune 100 firms and a variety of mid-market organizations across the full spectrum of industry verticals.

For contract roles Genesis10 offers the benefits listed below. If this is a perm-placement opportunity our recruiter can talk you through the unique benefits offered for that particular client. Benefits of Working with Genesis10:

• Access to hundreds of clients most who have been working with Genesis10 for 5-20 years
• The opportunity to have a career-home in Genesis10; many of our consultants have been working exclusively with Genesis10 for years
• Access to an experienced caring recruiting team (more than 7 years of experience on average)
• Behavioral Health Platform
• Medical Dental Vision
• Health Savings Account
• Voluntary Hospital Indemnity (Critical Illness & Accident)
• Voluntary Term Life Insurance
• 401K
• Sick Pay (for applicable states/municipalities)
• Commuter Benefits (Dallas NYC SF and Illinois)

For multiple years running Genesis10 has been recognized as a Top Staffing Firm in the U.S. as a Best Company for Work-Life Balance as a Best Company for Career Growth for Diversity and for Leadership amongst others. To learn more and to view all of our available career opportunities please visit us at our website.

Genesis10 is an Equal Opportunity Employer. Candidates will receive consideration without regard to their race color religion sex sexual orientation gender identity national origin disability or status as a protected veteran.