Director, Provider Relations & Contract Development in Memphis, TN at Beacon Health Options

Date Posted: 11/16/2019

Job Snapshot

Job Description

About the Position:

Beacon Health Options is currently seeking a dynamic Director of Provider Relations and Contracting to join our team in Little Rock, AR! The Director of Provider Relations and Contracting is a highly visible both internally and externally, leader of their assigned market that is leads a team that is accountable for the network development and contract management activities for a growing and complex managed behavioral health care organization.

The position is responsible for network development, recruiting for new business, contracting, and rate negotiations for their assigned territory.  In addition, this position supports and executes provider relations aspects of the provider strategy for existing business as set forth by Regional Operations and Partnerships leadership, directs provider relations activities to maintain and enhance the Regional provider network for existing clients, navigates Beacon’s matrix structure to engage, and coordinates and supports cross-functional Beacon stakeholders.  They are expected to be a thought leader in network operations, fee schedules, and reimbursement methodologies.

Position Responsibilities:

  • Leads a contracting team that leads the development and execution of network strategic plans that support are part of the various components of a winning Network strategic plan that establishes Beacon Health Options as leader in the behavioral health space. Is directly responsible for the contract strategic component that integrates the various other mission critical components of the overall Network Strategy of their assigned market/territory.
  • Is accountable to lead your department in support internal and external stakeholders, to successfully secure executed agreements that enhance access for Beacon Members, improves quality care and is in-line with the overall success of Beacon for all assigned books of business in assigned market to include Medicaid, Commercial, and Medicare books of business.
  • Validates for accuracy reimbursement analysis on providers/facilities as required for contract negotiations or other performance reports, department reports as they impact their assigned market/region.
  • Is well versed in all aspect of reimbursement methodologies and is considered a thought leader to internal departments in Beacon for DRGs, FFS, RVRBS, APCs, Per Diem, Case Rate and VBP, CPT and HCPC codes as it relates to contracting system payment configuration and claims payment.
  • Is well versed in Medicaid and Medicare program managed regulations for assigned market and has a team that is similar capable and up-to-date on relevant managed care regulations for their market.
  • Identifies opportunities for cost savings and process improvements related to the contracting process.
  • Directs provider contracting staff to assure day-to-day activities are performed effectively and support the assigned market network strategy, including meeting financial targets.
  • Ensures that departments properly reviews, draft and document suggested language changes, and oversee resolution of all proposed changes to the provider services agreement, secures appropriate internal approval on finalized changes, that are in-line with Beacon standards.
  • Ensures that Contract Language for products in their region/market is in compliance with plan agreements and within all state and federal regulatory and NCQA standards and kept updated.
  • Prepares reports and analyze data as directed by the Region AVP of Contracting or other members of the management team in the Network Department
  • Effectively lead the Provider Relations team as evidenced by provider, internal customer and client satisfaction, compliance with internal, client, regulatory and accreditation standards, successful audits, and employee satisfaction and engagement.
  • Direct Provider Relations staff to assure day-to-day activities are performed effectively and support the Region’s network strategy, including meeting financial targets.
  • In collaboration with Network Management Leadership, execute on a process improvement strategy which identifies provider satisfaction impacts and root cause of issues to achieve shorter provider inquiry response times, improved employee engagement, and higher provider satisfaction.
  • Serve as the network escalation point for Regional Leadership on provider relations issues.
  • Support and participate in the Network Management Department’s process improvement and transformational initiatives to drive completion and successful outcomes.
  • Assure the Provider Relations team is accountable to Network Management Leadership, Corporate Operations, and Regional Teams by meeting internal and external performance standards and guarantees.
  • Develop strong provider relationships built on trust and collaboration. Manage and balance Beacon and provider expectations.
  • Oversee coordination of practitioner and facility orientation and training.
  • Collaborate with the Quality and Legal Departments to perform complaint and grievance resolution and communication.
  • Contribute to provider communications such as newsletters, provider manual, mailings, and training.
  • Collaborate with the Network Development team to transition new business to ongoing operations.
  • Meet or exceed administrative budget targets.
  • Act as liaison and maintain productive working relationships with all Beacon departments.
  • Adheres to all Beacon policies and procedures and standards of operations.
  • Completes all required and assigned trainings.
  • Attends all mandatory company or department meetings.
  • Reports to each scheduled shift and commence work and perform essential job function at the start of each schedule shift.
  • Displays a positive, constructive, and helpful demeanor that is conducive to a safe and respectful work environment.
  • Acts as a mentor to junior team members by leading by example and guiding with a sense of integrity and team work.
  • Assists management with identifying opportunities for staff improvement, high performing team members, and training needs of team members.
  • Assist team members and offers suggestions to improve processes, culture, or work environment.
  • Performs special projects and other duties as assigned and required.

Position Requirements:

  • Education: Bachelor’s Degree in Business, Finance or Healthcare Management required
  • Relevant Work Experience: 5-8 years experience in Provider Relations, Contracting or similar managed care roles that includes rate & contract language negotiation and network operations required with at least 3-5 years of management experience
  • Knowledge, Skills, & Abilities:
    • In-depth knowledge and experience in provider reimbursement methodologies required
    • Knowledge of managed care contract requirements to include state and federal regulatory requirements for relevant commercial products, Medicaid plans and CMS guidelines required
  • Travel: up to 20% overnight and local travel required

Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment.  EOE/AA/M/F/Veterans/Disabled

At Beacon Health Options, our candidate's data privacy is a top priority. Our recruiting team conducts all communications using official company email (@BeaconHealthOptions.com). Only candidates who have applied for an open position through our Careers page (careers.beaconhealthoptions.com) will be engaged in our interview process. Beacon conducts all interviews in person or over the phone. At no time during the recruiting process will any Beacon recruiter request any financial or personally identifiable information from you.

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