Director Contract Development in Cypress, CA at Beacon Health Options

Date Posted: 11/1/2019

Job Snapshot

Job Description

ABOUT THE POSITION

We are currently seeking a dynamic Director, Contract Development to join our team. The Director, Contracting Development is a highly visible both internally and externally, leader of their assigned market. This person leads a team that is accountable for the network development and contract management activities for a growing and complex managed behavioral health care organization. This role is regionally focused with oversight of network for existing clients as well as recruiting for new business - including contracting and rate negotiations for their assigned territory.  The Director, Contract Development supports and executes provider strategy as set forth by Market and Regional leadership, leveraging the organization’s matrix structure to engage and coordinate support cross-functionally among key stakeholders. This person is an SME and thought leader in network operations, fee schedules and reimbursement methodologies.

Position Responsibilities:

  1. Manage a regional contracting team, ensuring day-to-day work is performed effectively and aligns with larger strategic objectives within the department and across the region, including financial targets.

  2. Lead regional contracting team in support of 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 (Medicaid, Commercial, and Medicare).

  3. Serve as escalation contact for Regional Leadership on provider contracting issues.

  4. Validate accuracy reimbursement analysis on providers/facilities as required for contract negotiations, performance and departmental reports as they impact their assigned market/region.

  5. Be the SME in reimbursement methodologies and thought leader within Beacon for DRGs, FFS, RVRBS, APCs, Per Diem, Case Rate and VBP, CPT and HCPC codes as they relate to contracting system payment configuration and claims payment.

  6. Identify opportunities for cost savings and process improvements related to the contracting process.

  7. Ensure compliance with Beacon standards and best practices throughout contracting process, and oversee resolution of all proposed changes to provider services agreements.

  8. Monitor Contract Language on all regional/market products, ensuring compliance with plan agreements and that Contracts are kept current within all state, federal and NCQA standards.

  9. Prepare reports and analyze data as requested by the Regional VP and other company or departmental leaders.

  10. Collaborate with Network Strategy leadership to execute on process improvement initiatives related to provider satisfaction impacts and root cause of issues, to achieve shorter provider inquiry response times and increase provider satisfaction.

  11. Develop strong provider relationships built on trust and collaboration. Manage and balance Beacon stakeholder and provider expectations.

  12. Oversee coordination of practitioner and facility orientation and training.

  13. Support transition of new business to ongoing operations in collaboration with other Beacon teams and departments.

  14. Collaborate with the Quality and Legal Departments to perform complaint and grievance resolution and communication.

Position Requirements:

Education: Bachelor’s level in health administration or business. Master’s level preferred.

 Licensure:  N/A

Relevant Work Experience:  

  • Minimum 5-8 Years of work experience with direct experience in Contracting or similar managed care roles that includes rate & contract language negotiation and network operations.

  • In-depth knowledge and experience in provider reimbursement methodologies.

  • Well versed in Medicaid and Medicare program managed regulations for assigned market.

  • Minimum of ten years of direct behavioral health experience, five years of experience working in a managed care environment, and at least three years’ experience in a client facing leadership role.

 Knowledge, Skills & Abilities:

  • Excellent written, oral, and presentation skills

  • Strong relationship building skills with ability to effectively present to large groups

  • Computer Skills: Microsoft Outlook and Word with Excel skills

  • Excellent communication and leadership skills to lead and motivate a growing and changing service operation; able to engage with directors and managers at all levels across the business to achieve goals and objectives

  • Ability to manage and coordinate with internal and external departments

  • Able to work collaboratively with internal staff and external stakeholders (provider organizations, clients, etc.)

  • Ability to travel

Beacon Health Strategies, LLC., a Beacon Health Options company, is proud to be an Equal Opportunity Employer as well as a Drug Free Work Environment. EOE/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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