Managed Care Finance Director directs and oversees all policies and procedures for the financial and data operations of managed care contracts. Manages contracts, negotiates and sets rates, and reviews reimbursement levels and managed care agreements to ensure that proper payment practices are utilized. Being a Managed Care Finance Director implements processes that encourage and inform the organization how to increase levels of reimbursements. Requires a bachelor's degree. Additionally, Managed Care Finance Director typically reports to top management. The Managed Care Finance Director manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function. To be a Managed Care Finance Director typically requires 5+ years of managerial experience. (Copyright 2024 Salary.com)
Description
GENERAL OVERVIEW :
This job serves as the primary negotiator for Single Case Agreements related to non-contracted entities, while also being responsible for facility / ancillary credentialing for the entire Allegheny Health Network.
It maintains compliance with the No Surprises Act by reviewing andnegotiating Qualified Payment Amounts, administering and serving as the subject matter expert (SME) for the Electronic Contract Repository, and maintaining Network Participation Tools for internal and external consumption.
ESSENTIAL RESPONSIBILITIES
Negotiates and processes payor and employer single case agreements timely and accurately. Continually follows up on singe case agreements until complete and ensures compliance with terms of the single case agreement.
Collaborates with Allegheny Health Network (AHN) Revenue Cycle and Managed Care team to ensure proper billing and timely follow-up on single case agreements. 40%
Completes and submits facility credentialing and re-credentialing applications with all payors accurately and in a timely manner (including but not limited to hospital, ASC, and ancillary entities.
Resolves credentialing issues through collaboration with management, related departments, insurers and others as identified.
Monitors and maintains key credentialing dates for all payors.15%
Serves as primary intake for new contract documents and catalogs pertinent contracting language and events. Serves as department SME for Contract Repository System.10%
Maintains patient access matrix for internal consumption. Maintains and updates patient access matrix for external consumption.
Collaborates with IT and Marketing to ensure timely updates to company websites.10%
QUALIFICATIONS : Minimum
Minimum
Preferred
1 year of Managed Care experience
Pay Range Minimum : $25.85
$25.85
Pay Range Maximum : $40.18
$40.18
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Equal Opportunity Employer Minorities / Women / Protected Veterans / Disabled / Sexual Orientation / Gender Identity ()
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