Director of Managed Care

Description

Compass Health Center is seeking an experienced Director of Managed Care to join our growing organization. Compass Health Center is one of the largest providers of PHP/IOP services in North America. Based in Illinois (Chicago and Northbrook), Compass provides crisis-level mental health care in a comfortable, outpatient setting. Our 14 programs are supported by 21 psychiatrists, 160 clinicians (LCPC, PhD, MSW) and nearly 100 administrative employees.

This position will be responsible for leading all of the company's managed care contracting functions, including payer contract identification, negotiation, procurement, performance monitoring, management of payer relationships, and credentialing.

Responsibilities Include:

• Payer Contracting: Managing all components of the contract negotiation process. Identifying the key payers in new markets into which the Company enters
• Lead the rate and language negotiation discussions with the payers
• Work with the Executive Director and Director of Finance to ensure negotiated rates are acceptable and will add value
• Payer Relations: Develop professional relationships with contracted payers. Works with the Company's Billing Department as needed to discuss/resolve claim issues resulting from contract interpretation and/or language
• Monitoring changes in payer policies affecting reimbursement or administration and any emerging payer concerns. Keeping up-to-date of marketplace changes for payers, networks, reimbursement issues and changes in guidelines
• Credentialing: Oversee the process of health plan enrollment / credentialing applications for facilities and licensed providers with all health plans. Ensure that all payer contracts are renewed prior to expiration

Requirements:

• Bachelor's Degree in healthcare management or related field. Master's degree preferred
• Minimum seven (7) years of experience working with a healthcare company or health plan directly focused on payer contracting and facility/provider enrollment; experience with payers on the east coast preferred
• Strong technical knowledge of payer contracting, including language review, contract format and structure, and reimbursement methodologies
• Strong technical knowledge of managed care contracting, payer policies, hospital and physician reimbursement methodologies, and state and regulatory requirements
• Track record of successful negotiations between major payer organizations and healthcare providers
• Strong organizational and interpersonal skills, with ability to communicate effectively
• Excellent organizational and analytical skills

The benefits of working at Compass Health Center:

Compass Health Center offers our full time employees a competitive total compensation package, including:

• Comprehensive Health, Dental, Vision and Accident Insurance
• 401K with generous company match
• Increased PTO with years of employment
• Performance based raise structure, with the opportunity for annual raises