Director, Managed Care Contracting and Payor Compliance

Company Summary

If you are searching for a fulfilling place to develop your career and an opportunity to make a difference in helping others, then keep reading on. Here at AAC, we have a progressive culture; we listen to your ideas, value a work/life balance, invest in education, and we foster trust and respect for all individuals. Our exceptional comp and strong benefits include company matching 401K, medical, dental, vision and life insurance. We are looking for our future leaders, who are not only going to fill the qualifications for this job description, but who are going to exceed expectations. Be a part of a team whose mission is to provide quality, compassionate, and innovative care to adults struggling with addiction and co-occurring mental health disorders. Our purpose and passion are to empower patients, their families, and our communities by helping individuals achieve recovery and optimal wellness of the mind, body, and spirit.

Job Summary

The Director of Managed Care and Payor Compliance is responsible for the development, negotiation, implementation and management of contracts with third-party payors, ensuring compliance with regulatory requirements and maximizing revenue. This role involves both contracting and compliance functions, ensuring the organization’s financial health and legal standing within the managed care landscape.

Duties and Responsibilities:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

• Leads the process of developing, negotiating and executing managed care contracts with government and third-party payors.
• Responsible for ensuring all relevant parties including Operations, Clinical, Finance and Billing Teams are privy to specific payor rules, regulations and other contractual obligations.
• Leads company efforts in establishing quality metrics needed to assist with contract negotiations using outcome-based reporting that will support the value-based care reimbursement models.
• Identify revenue opportunities with existing and prospective payor agreements.
• Maintain contract renewal schedule to ensure timely review and renegotiation of contracts.
• Provide reports and analysis of performance, providing recommendations and feedback for contract renewals, renegotiations, or termination.
• Partner with leaders within Revenue Cycle, Business Development, Facility Operations, Finance and Quality Assurance regarding contracting, financial and strategic objectives.
• Monitor the financial and operational performance and trends of payor contracts and report to the Executive Team.
• Performs other related duties and special projects as assigned.

Education/Experience:

• Bachelor’s degree in Business Administration, Health Care Administration, or equivalent/related field. (Master’s preferred)
• Extensive knowledge of different payor models and contract terms
• Strong negotiation skills with health plans and other stakeholders
• Ability to analyze and interpret financial data related to managed care contracts
• Knowledge of relevant laws and regulations and the ability to ensure compliance
• Experience in collaborating with RCM, Business Development, Facility Operations, Finance and Clinical Leadership to identify opportunities to promote preferred provider status
• 7+ years of related experience negotiating hospital, large physician groups and ancillary services agreements and external customer service for providers
• Experience in marketing/sales/finance in a managed care or insurance environment
• In depth understanding of credentialing requirements for facility and professional services contracting and the ability to manage accordingly
• Experience with negotiating national-level contracts with Payor Executives. Possesses an understanding of Payor operations.

Supervisory Responsibility

• Responsible for leading and coaching a team
• Oversees the daily workflow of the department
• Provides constructive and timely performance evaluations

Physical Requirements

“AAC is committed to principles of equal opportunities for all employees.  The Company will provide reasonable accommodations that are necessary to comply with State and Federal disability discrimination laws.”

• Prolonged sitting at a desk
• Must be able to lift 15 pounds at a time

American Addiction Centers is an equal opportunity employer.  American Addiction Centers prohibits employment practices that discriminate against individuals or groups of employees based on age, color disability, national origin, race, religion, sex, sexual orientation, pregnancy, veteran or military status, genetic information or any other category deemed protected by state and/or federal law.