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.
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.
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.
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.
Amedisys Home Health Services