Vice President of National Managed Care Contracting
# of Openings
3 months ago(8/23/2018 5:35 PM)
Reports to: CEO – AAC Lab Operations FLSA Status: Exempt
Direct/lead Laboratory Managed Care articulating the value proposition and communicates toxicology, specialty testing, genetics, pharmacogenetics pathology and esoteric testing offerings to health plan contracting and medical teams.
Assist in securing coverage and reimbursement for new technology and focus tests.
Work with health plans to improve coverage positions for toxicology testing.
In accordance with the Legal Team rules and procedure, responds to proposals and contracts. Negotiates pricing, execution and implementation of the contracts for selected Managed Care accounts. Assist in the review of managed care contracts from a financial and operational basis and work with division/regional operations, finance, billing, legal and business development, teams to represent laboratory interests in contract negotiations.
Assist with and responsible for assigned relationships and communication with Managed Care plans. Periodic meetings with each plan as required. Quality reporting, Lab Leakage Initiatives, operational initiatives, demographic updates, new technology, etc. should be reviewed at joint operational meetings with customers.
Keep informed of developments and trends relating to all areas of the company and MCO/PPO plans.
Works with billing leadership to communicate contract specifics for new plans and changes in data requirements for existing plans to the field.
Assists managed care coordinator/director in conjunction with legal department on all contracts.
5+ yrs growing laboratory state and national managed care programs (gov & commercial).
Demonstrated knowledge of managed care, including managed Medicare and Medicaid, and other payor’s guidelines and criteria for reimbursement.
5+ yrs of contracting team development/management.
Familiar with insurance billing, coding and terminology.
Strong analytic computer and software skills.
Excellent interpersonal skills including excellent verbal and written communication skills.
Demonstrated knowledge of customer service skills when responding to questions and other inquiries from internal and external customers.