- Experience with (LTSS) Long-Term Services and Supports and ancillary
- Possess a solid understanding of Medicare and Medicaid reimbursement methodologies
- Experience with multiple product lines including Medicare, Medicaid and Commercial
Minimum Education Required
- Bachelor’s Degree. Master’s Preferred in Business, Public Health, Public Policy, or related field.
- Minimum seven years of experience in health care, with minimum five years in provider contracting
- Must have supervisory experience and demonstrated ability to work with staff to achieve goals
- Experience with leadership in provider contracting and health care reimbursement
Description on position
The Director of Contracting, Ancillary and Community-based Services will be responsible for obtaining and maintaining a network of ancillary, behavioral health, and long-term services and supports (LTSS) to meet the needs of members, maintain facility’s high quality ratings, support financial sustainability. In addition, this individual will help design and execute reimbursement strategies to achieve these goals.
Key Duties and Responsibilities
- Lead the development and maintenance of the organizations ancillary, behavioral health, and LTSS network through the management of the ancillary and community-based services contracting team, oversight of contract negotiations, and provider relationship development.
- Provide strong leadership and management to staff of contract managers and contract specialists, including the development and maintenance of work flows, processes, performance metrics, and management tools to foster an environment of professionalism and performance excellence.
- Develop and execute contracting strategies for ancillary, behavioral health, and LTSS contracts that support the clinical, programmatic, and financial goals of the organization.
- Work with leadership and contracting team to strategize and prioritize provider recruitment and re-contracting activities in compliance with regulatory and corporate requirements.
- Oversee and directly lead the pursuit, negotiation, analysis, and implementation of fee-for-service and performance and risk-based health system and primary care agreements.
- Effectively and professionally represent organization with providers and provider organizations.
- Maintains positive working relationships with contracted providers, systems, and institutions.
- Has ability to identify synergy between organization and potential new providers, and effectively implement and maintain these new provider relationships.
- Effectively promote and convey the concept of organizations Care System Design of full integration of medical, behavioral health and long-term care services to new providers.
- Develop and maintain work flows, processes, performance metrics, and management tools to foster an environment of professionalism and performance excellence.
- Provide coaching, mentoring, support, and oversight in the contracting and contract negotiation process, drawing upon experience and subject matter expertise.
- Secondary Responsibilities
- Collaborates with and builds strong partnerships across the organization to align network recruitment and management activities with membership and clinical care goals, regulatory compliance, and other organizational priorities.
- Possess a solid understanding of Medicare and Medicaid reimbursement methodologies.
- Actively participates in the evaluation of own performance. In-state travel to meet with contracted and prospective providers
The Director of Contracting, Ancillary and Community-based Services will manage a team of 8-10 professional staff members (Contract Manager, Senior Contract Manager, Contract Specialist levels)