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Director Of Payor Operations

Expired Job

Amedisys Home Health Services Baton Rouge , LA 70804

Posted 4 months ago

Job Summary:

This key leadership position is part of the Payor Relations & Network Innovation team and is responsible for the operational support and data management of contracted payor relationships.

Essential Functions:

  • Accountable for managing payor contract compliance, payor escalation process, payor data management and notifications, credentialing, as well as related education and reference tools. Directly leads and develops team members.

  • Monitors, forecasts, and interprets financial and operational performance of private payors to determine variation from expected results, including but not limited to: contract performance, utilization of services, service line performance, DSO, aged A/R, bad debt, write-offs and additional overhead allocations required to support related lines of business.

  • Provides knowledge, insight and informed guidance in updating agreements to achieve strategic business objectives.

  • Identifies and resolves root causes of payor escalation projects in order to reduce contractual write-offs resulting from external payor and/or internal operational non-compliance with the contract.

  • Ensures 100% participation for all contracted payors via timely, accurate, and compliant credentialing and recredentialing of our agencies and proactive monitoring of changes in requirements.

  • Ensures payor source codes for all contracted providers are accurate and updated timely to reflect adds/terms/edits, including audits that confirm that HCHB payor source codes accurately reflect the contract, contract summary, PCR form.

  • Manages timely and accurate resolution of help desk tickets and seeks to provide helpful resources to reduce common inquiries.

  • Manages proactive notifications of contract status change and provides other notices and/or educational tools regarding participation in plans and operational requirements. This includes webinars and conference calls as well as appropriate job aids, sharepoint and other portal resources and tools.

  • Maintains relationships with internal stakeholders as well as with vendors, payors, and other third parties in order to enhance payor relationships.

  • Fosters strong collaborative relationships with the regulatory team and proactively monitors for relevant payor updates, CMS updates, VA updates, state funded/Medicaid program updates, and identification or escalation of potential updates to contracts and/or systems.

  • Proactively manages adherence to the contract renewal process, including managing process steps associated with contracting critieria compliance, obtaining required approvals, and managing notice/renewal dates.

  • Monitors and evaluates employee performance. Holds employees accountable for the attainment of defined goals and objectives. Executes effective performance redirection when needed. Develops employees through coaching, mentoring, and formal/on the job training and development opportunities.

Qualifications:

Required

  • Bachelor's degree in Business Administration or related field; OR equivalent work experience.

  • Six (6 ) years' experience in payor contracting support, revenue recovery or related operations.

  • Direct experience with credentialing business processes.

  • Three (3 ) years' prior management experience.

Preferred

  • Master's degree in Business Administration or related field.

  • Payor/Provider contracting experience with a health plan and/or with home health and hospice fields.

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Director Of Payor Operations

Expired Job

Amedisys Home Health Services