What are the responsibilities and job description for the Director, Health Plan Contracting position at Groups Recover Together, Inc.?
Overview:
Duties & Responsibilities
Groups is a rapidly growing, mission-driven healthcare company that provides affordable, evidence-based treatment for opiate addiction. Our model uses two of the most powerful tools for recovery: group therapy and medication-assisted treatment with buprenorphine. Our approach takes the best parts of AA (accountability and community) and combines them with the latest medical science and technology.
Responsibilities:
At Groups, the Director of Health Plan Contracting will be responsible for directing the operational component of the ongoing relationships with our contracted health plan partners throughout the partner lifecycle. The position will collaborate across the growth, RCM, analytics, and operations teams to manage health plan data and analysis, support quarterly meetings, support kickoff meetings and the ongoing management of the contract. The Director will work with the SVP Partner Success to identify trends and prepare reporting to demonstrate differentiated outcomes. The Director of Health Plan Contracting will also be responsible for the infrastructure behind Partner Success, such as updates for key information such as: contracts and key deliverables, and the payer contract management system (PCMS) administration. The Director will also be responsible for managing a team when appropriate.
Duties & Responsibilities
- Operationalize contracts – quarterback the translation into RCM, services, etc.
- Operationalize contracts into the contract models and conduct reviews
- Manage the PCMS - contract meta data updates, workflow updates, security, fee schedules, etc.
- Monitor AR, claims denials, etc. for creation of the health plan scorecard and provide guidance
- Ensure provider portals and other health plan contacts and resources for operations are kept updated
- Direct value-based contract reconciliation
- Direct and create health plan reporting; Track leading indicators of outcomes, analyze, and make recommendations for improvements. Identify new processes and tools to increase automation and improve efficiency
- Build relationships across the organization, including sales, operations, analytics, RCM, and leadership to become an integral part of a cross-functional team
- Stay abreast of market conditions, industry best practices and partner needs
You are the ideal candidate if you have:
- BS/BA required,
- 10 years of healthcare industry experience, including operational experience in claims, credentialing, payer contract management
- Proven track record of success in operational positions with Health Plan and or healthcare services organizations,
- Solid Project Management skills
- Excellent reporting and organizing data in a digestible and impactful format
- Excellent communication skills
- Strong interpersonal, communication and presentation skills
- Ability to create and manage complex projects
- Ability to manage a team of analysts
- Ability to collaborate across the organization to accomplish goals
- Strong analytical capability and data orientation
- Proficient in Microsoft Office and comfortable using analytic tools such as Tableau
- COVID-19 considerations: COVID vaccine required for all employees who are hired to work in an on-site setting, or who will be working at any time directly with our member population.
