GI Alliance
Executive Director of Payer Relations
GI Alliance - Southlake, Texas, United States, 76092
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Description
GI Alliance is seeking an experienced Executive Director of Payer Relations. Description
GI Alliance is seeking an experienced Executive Director of Payer Relations.
Duties of this position include, but are not limited to, the following:
Position purpose
Responsible for initial negotiation and final implementation of Managed Care contracts (e.g., HMO, PPO, EPO, government, medical group, capitation contracting) for GI Alliance. Responsible for strategic planning; document management; relationship management and contracting activities related to managed care contracting. The position is also responsible for contract oversite and training to ensure proper execution of contracts.
Responsibilities/Duties/Functions/Tasks
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Develop strong relationships with health plans and medical directors to achieve in-network coverage decisions and reimbursements. Research and identify profitable networks for consideration. Initiate and lead the process of development, implementation, monitoring and management of all managed care agreements. At the direction of the COO, CFO and CEO participate in contract negotiations and pricing to drive profitable revenue growth. Maintain a high level of expertise in pricing arrangements, contract requirements/contract language, value-based initiatives with the various health plans, etc. Evaluate opportunities for new contracting strategies with performance-based or value-based contracting. Evaluate ACOs in markets where GI Alliance performs services. Determine strategic ACO partners and align with the ACOs to increase patient volume and revenue for GI Alliance. Analyze financial reports to determine the impact of contract negotiations, updates to fee schedules, etc. Work with health plans and present information to COO, CEO, and GI Alliance physician leadership to finalize contract rates. Ensure new contract rates are loaded and claims payments are made correctly according to the contracts. Evaluate existing agreements to ensure they are structured to maximize profitability and limit the exposure to financial decreases. Take appropriate actions to resolve contract issues and complaints. Maintain updated records and price schedules. Manage process for timely renewals of contracts in collaboration with operations. Responsible for educating the GI Alliance provider offices on any specific contract initiatives, such as performance based reimbursement or value-based program requirements. Counsel with provider office staff to ensure they are aware of any health plan policies and procedures. Assist with ongoing provider servicing issues. Ensure GI Alliance practitioners are loaded in the health plans correctly. Communicate and interact effectively and professionally with co-workers, management, physician leadership and with the staff at each GI Alliance location. Maintain confidentiality of company business. Train and educate affected personnel for effective and compliant execution of contracts. Provide tracking and analysis of contract performance to Executive management. Act a contract subject matter expert. Providing daily oversight and guidance to employees. Direct regular meetings to review contract performance and issues. Maintain a good working relationship with management team attend monthly meetings. Retain employee files to document (i.e. personal data, reference checks, compensation, benefits, payroll information, attendance, performance reviews or evaluations, and termination date and reason). Compliance with HIPAA and all related federal and state regulations. Compliance with all GI Alliance policies. Travel as needed. Other duties as assigned.
Qualifications
Qualifications
EDUCATION:
Bachelors Degree in related field such as business; health care or finance required. Masters Degree in Health Care Administration preferred.
EXPERIENCE:
Minimum of ten years progressive experience in contract management with a minimum of five years experience in a management role.
Performance Requirements
Knowledge of Texas health plans. Knowledge of medical terminology and insurance practices. Knowledge of financial and analytical practices. Extensive knowledge of provider and value-based contracting to include, financial analysis, credentialing, legal review, implementation, compliance and utilization of data. Thorough understanding of professional fee schedules/reimbursement methodologies. Knowledge of CPT and ICD-10 coding. Knowledge of managed care, Medicare, and Medicaid guidelines. Skill in effective personnel management including training staff and delegating duties. Skill in written and verbal communication. Ability to work effectively as a team member with physicians and other staff. Ability to flexibly respond to changing demands. Ability to plan, organize, prioritize and direct the work of others. Ability to establish and maintain effective working relationships with managed care companies, employees, and the public. Prior experience interviewing candidates and determining staffing needs. Experience managing patient issues. GI Alliance is an Equal Opportunity Employer. We are committed to creating an inclusive, welcoming, and equitable work environment. Our company values and celebrates the diversity of our physicians, staff and patients. We firmly believe our service is greatly enriched by our diversity of thought, experience, perspective, culture, and background.
Please Note: All job offers are contingent on the successful completion of pre-employment criminal history check.
NOTE: ALL APPLICATIONS MUST BE COMPLETED IN FULL FOR CONSIDERATION.
No phone calls or agencies, please.
EEO/AA-M/F/disabled/protected veteran Seniority level
Seniority level Executive Employment type
Employment type Full-time Job function
Job function Business Development and Sales Industries Hospitals and Health Care Referrals increase your chances of interviewing at GI Alliance by 2x Sign in to set job alerts for “Director Relations” roles.
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GI Alliance is seeking an experienced Executive Director of Payer Relations. Description
GI Alliance is seeking an experienced Executive Director of Payer Relations.
Duties of this position include, but are not limited to, the following:
Position purpose
Responsible for initial negotiation and final implementation of Managed Care contracts (e.g., HMO, PPO, EPO, government, medical group, capitation contracting) for GI Alliance. Responsible for strategic planning; document management; relationship management and contracting activities related to managed care contracting. The position is also responsible for contract oversite and training to ensure proper execution of contracts.
Responsibilities/Duties/Functions/Tasks
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Develop strong relationships with health plans and medical directors to achieve in-network coverage decisions and reimbursements. Research and identify profitable networks for consideration. Initiate and lead the process of development, implementation, monitoring and management of all managed care agreements. At the direction of the COO, CFO and CEO participate in contract negotiations and pricing to drive profitable revenue growth. Maintain a high level of expertise in pricing arrangements, contract requirements/contract language, value-based initiatives with the various health plans, etc. Evaluate opportunities for new contracting strategies with performance-based or value-based contracting. Evaluate ACOs in markets where GI Alliance performs services. Determine strategic ACO partners and align with the ACOs to increase patient volume and revenue for GI Alliance. Analyze financial reports to determine the impact of contract negotiations, updates to fee schedules, etc. Work with health plans and present information to COO, CEO, and GI Alliance physician leadership to finalize contract rates. Ensure new contract rates are loaded and claims payments are made correctly according to the contracts. Evaluate existing agreements to ensure they are structured to maximize profitability and limit the exposure to financial decreases. Take appropriate actions to resolve contract issues and complaints. Maintain updated records and price schedules. Manage process for timely renewals of contracts in collaboration with operations. Responsible for educating the GI Alliance provider offices on any specific contract initiatives, such as performance based reimbursement or value-based program requirements. Counsel with provider office staff to ensure they are aware of any health plan policies and procedures. Assist with ongoing provider servicing issues. Ensure GI Alliance practitioners are loaded in the health plans correctly. Communicate and interact effectively and professionally with co-workers, management, physician leadership and with the staff at each GI Alliance location. Maintain confidentiality of company business. Train and educate affected personnel for effective and compliant execution of contracts. Provide tracking and analysis of contract performance to Executive management. Act a contract subject matter expert. Providing daily oversight and guidance to employees. Direct regular meetings to review contract performance and issues. Maintain a good working relationship with management team attend monthly meetings. Retain employee files to document (i.e. personal data, reference checks, compensation, benefits, payroll information, attendance, performance reviews or evaluations, and termination date and reason). Compliance with HIPAA and all related federal and state regulations. Compliance with all GI Alliance policies. Travel as needed. Other duties as assigned.
Qualifications
Qualifications
EDUCATION:
Bachelors Degree in related field such as business; health care or finance required. Masters Degree in Health Care Administration preferred.
EXPERIENCE:
Minimum of ten years progressive experience in contract management with a minimum of five years experience in a management role.
Performance Requirements
Knowledge of Texas health plans. Knowledge of medical terminology and insurance practices. Knowledge of financial and analytical practices. Extensive knowledge of provider and value-based contracting to include, financial analysis, credentialing, legal review, implementation, compliance and utilization of data. Thorough understanding of professional fee schedules/reimbursement methodologies. Knowledge of CPT and ICD-10 coding. Knowledge of managed care, Medicare, and Medicaid guidelines. Skill in effective personnel management including training staff and delegating duties. Skill in written and verbal communication. Ability to work effectively as a team member with physicians and other staff. Ability to flexibly respond to changing demands. Ability to plan, organize, prioritize and direct the work of others. Ability to establish and maintain effective working relationships with managed care companies, employees, and the public. Prior experience interviewing candidates and determining staffing needs. Experience managing patient issues. GI Alliance is an Equal Opportunity Employer. We are committed to creating an inclusive, welcoming, and equitable work environment. Our company values and celebrates the diversity of our physicians, staff and patients. We firmly believe our service is greatly enriched by our diversity of thought, experience, perspective, culture, and background.
Please Note: All job offers are contingent on the successful completion of pre-employment criminal history check.
NOTE: ALL APPLICATIONS MUST BE COMPLETED IN FULL FOR CONSIDERATION.
No phone calls or agencies, please.
EEO/AA-M/F/disabled/protected veteran Seniority level
Seniority level Executive Employment type
Employment type Full-time Job function
Job function Business Development and Sales Industries Hospitals and Health Care Referrals increase your chances of interviewing at GI Alliance by 2x Sign in to set job alerts for “Director Relations” roles.
Brand Experiences & Partnerships Director
Director Business Development Professional Services
Director, Customer Engagement & Decisioning
Director, Business Development- Food & Beverage
Director of Business Development (Remote)
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Dallas, TX $100,000.00-$115,000.00 6 days ago Director of Business Development – North America
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We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
#J-18808-Ljbffr