For over 30 years, New Season Treatment Centers have been a leading national health care service provider of outpatient treatment centers that specialize in providing safe, quality and best in class care for individuals living with Opioid Use Disorder ("OUD").
Operating in over 70 treatment centers in multiple states, our team members are engaged in medication-assisted treatment, counseling, support, and care management of individuals living with OUD. We treat the whole person and, in so doing, address the underlying causes of OUD in an effort to provide a continuum of care that not only addresses treatment needs but supports the patient on their journey to recovery.
DIRECTOR OF PAYOR RELATIONS
Job Description
New Season
Reports to: Sr. Vice President Revenue Mgmt
Job Code: 270
Department: Payor Relations
FLSA: Exempt
Direct Reports: 6+
Job Summary:
This position is responsible for maintaining contractual relationships with payers and health plans. Facilitates payer contracting activities, including contract review, negotiation of terms, strategic positioning, provider enrollment, dispute resolution and growth opportunities. Responsible for the maintenance of managed care plan operating policies and systems; developing effective relationships with payers and providers related to those managed care plans; coordinating the analysis, reporting and negotiation of payer contracts.This position also oversees the charge data master (CDM) and practice management database where provider, location and group information is stored for business purposes.
Essential Functions:
Supervisory Responsibilities:
(This position will supervise exempt and non-exempt staff in support roles performing duties described in "Essential Functions".)
This position will supervise up to three positions including but not limited to the Credentialing Coordinators, Contract Administrator , RCM Analysts.
This position will have dual-supervision of the Grant Administrator.
Essential Qualifications:
(To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the competencies (minimum knowledge, skill, and ability) required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions).
Education/Licensure/Certification: This position requires a Bachelor's Degree in business or related field required.
Required Knowledge: The ideal candidate will have a strong oral and written communication and relationship building skills. Also, knowledge of the contracting process; knowledge of major U.S managed care and non-managed care health insurers.
Experience Required: The ideal candidate will have a minimum of 5 years of third-party healthcare insurance contracting experience, and experience with behavioral healthcare organization preferred. This position will also include strong knowledge and experience in developing and executing a third-party payor network strategy. Thorough knowledge of the experience with healthcare regulatory environment, and strong industry relationships with managed care/non-managed care third party payors.
Skill and Ability: The ideal candidate will have the ability to work collaboratively with colleagues. Strong organizational skills with a keen ability to prioritize and multitask. Ability to adhere and meet deadlines. Good communicator. Strong administrative and management skills. Ability to raise issues proactively in a timely manner. Strong presentation skills.
Physical Demands/Work Environment:
(The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.)
Finger Dexterity: Use primarily for writing, operating calculator, telephone, keyboard and other office equipment.
Talking: To convey detailed or important instructions to employees, patients and applicants.
Hearing: Ability to hear normal conversations and receive ordinary information.
Vision: Average, ordinary, visual acuity necessary to observe patients and work on the computer. Clear vision at 20 inches or less and distant vision at 20 feet or more.
Physical Strength: Sedentary work; sitting most of the time. Exerts up to 10 pounds of force occasionally.
Working Conditions:
(The working conditions described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.)
Core Competencies:
Mental Activities:
(The mental activities described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.)
Reasoning Ability: Ability to resolve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram or schedule form. Ability to maintain confidentiality.
Mathematics Ability: Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumferences and volume.
Language Ability: Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, and governmental regulations. Ability to write reports and business correspondence. Ability to effectively present information and respond to questions from groups of managers, employees, patients and the general public.
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