Position Summary

This leadership position is responsible for directing and leading all payer relations, managed care, revenue capture, optimization and credentialing functions across all service lines. Reporting to the VP of Revenue Cycle, the Strategic Payer Relations Director will take a “hands on approach” in contributing significantly to the concept, design, and implementation of the organization’s reimbursement function(s) to accommodate the company’s rate of growth while driving performance improvement in professional fee collections via process improvements, deployment of alternate/value-based payment models, chargemaster, and the creation of internal capabilities to the end of making revenue cycle management a competitive advantage for the organization.

The Strategic Payer Relations Director supervises the Reimbursement Payor/Payor Contracting, Payor Meetings, Credentialing, and Charge description master functions and maintains responsibility for the overall direction, coordination, and evaluation of these units. This leadership role will ultimately manage workflow and resolve problems to achieve peak productivity, as well as train, motivate, and manage team members for optimal performance.

Work Schedule

Monday through Friday, 40 hours/week, or as work needs demand.

Primary Duties

• Oversees and/or performs all aspects of the licensing, credentialing, and government contracting.
• Responsible credentialing and oversight of Charge Description Master functions and reimbursement analysis.
• Lead and direct all credentialing activities related to government, commercial insurance, state licensing, and business-related contract forms.
• Review, design, and implement processes surrounding provider profiles, credentialing with various payers, contract maintenance, application preparation, credentialing reappointment, provider databases, and facility databases.
• Provides leadership in development, implementation, and oversight of system-wide/regional standards, programs, and/or systems in order to achieve desired and integrated strategic business initiatives, objectives, and outcomes including, but not limited to, growth, accountability and patient care.
• Directs, supervises, and evaluates the work of staff. Holds staff accountable for achieving plans and performance targets. Works with them to identify and resolve the most complex issues and problems impacting initiatives and operations. Develops staff to ensure continued professional growth and to provide the competencies the company needs to support its growth and long-term success. Articulates and demonstrates an expectation for continuous quality improvement utilizing processes that include consideration of all stakeholders. Fosters an environment that focuses on processes and outcomes.
• Builds and supports effective collegial relationships with applicable internal and external stakeholders and organizations, ensuring and fostering a high level of collaboration in order to develop partnerships, coordinate activities, review work, exchange information, and/or resolve problems. Promotes and models positive relationships among various entities.
• Oversees the development, implementation, and consistent application of effective organizational policies and practices. Participates in maintaining an effective internal control environment to ensure that assets are safeguarded, policies and operating procedures are followed, necessary controls are effective and efficient, proper compliance with existing laws and regulations achieved, and operations comply with the legal and regulatory parameters in which it operates.
• Develops, reviews, and monitors financial and performance outcomes to assure attainment of organizational objectives established by corporate leadership and the Board of Directors. Maintains an effective budgeting and capital planning discipline in conjunction with operational management to ensure planned revenues, expenses, and/or profit goals are met.
• Directs the development and integration of new and innovative operations and/or services by providing leadership that maximizes management staff’s contributions and assures timely decision-making reflective of the mission, vision, and values of the system.
• Reviews, prepares, analyzes, and presents reports and recommendations to senior management regarding operations and/or other applicable areas of interest in order to provide concise and accurate information that aids in decision-making.
• This position has administrative leadership responsibility for the daily operation of multiple services and departments within a broad division. This position requires the skill to negotiate. Customers of this position are both internal and external, including leadership, staff, medical staff, regulatory agencies, and the community.
• Responsible for the oversight of Charge Description Master functions and reimbursement analysis within the Revenue Management Department.
• Responsible for building / maintaining charge codes and working with revenue leakage opportunities.
• Responsible for conducting quality control audits to ensure data/documentation integrity, and communicating findings and recommendations, explaining regulatory requirements, and overseeing the corrective actions for audits within the operational units for Charge Description Master.
• Compile information and/or prepare reports and analyses setting forth results of data integrity findings with appropriate recommendations; perform subsequent audits to ensure complete and appropriate corrective action for timely completion of missing charges by department.
• Serves as EHR Implementation Lead.
• Maintains effective communication and relations with practitioners, employees, other departments, administration, the governing body and the public/community.
• Performs other duties as assigned.

Qualifications/Specifications

• Education: Bachelor’s degree in finance, business administration, healthcare administration, or related field. Master’s degree preferred.
• Licensure/Certification: None required. Certified Medical Staff Coordinator (CMSC) or Certified Provider Credentialing Specialist (CPCS) through NAMSS preferred.
• Experience: Minimum of five years’ experience working in practice and provider enrollments with Medicare, Medicaid, and Commercial payers.  Minimum of three years of managerial experience required.