Job Description
The Director - Managed Care is responsible for creating, leading and conducting all managed care activities for Baptist Health Care corporation (BHCC). This role will support and further the organization in its goals for growth, competition and financial strength. By securing optimal reimbursement and protecting the interests of the system in contract negotiations and the implementation and management of managed care contracts and relationships, this position is essential to the hospital's financial performance. This position will contribute to strategic planning and strategy implementation as related to managed care; planning, organizing, directing and conducting the negotiations; and implementation of managed care agreements with current and prospective purchasers or providers of healthcare services on behalf of BHCC. The position will be charged with coordination and communication between the managed care department and other key stakeholders such as hospital operations and physician group leaders, as well as external constituents such as brokers and payers.
Responsibilities
- Work with all revenue cycle departments to leverage information to be used in managed care contract negotiations, implement denials management process improvements, and increase revenue streams.
- Work closely with employed physician groups and the IPA in the market regarding managed care contracts, strategies for improving market share, financial performance of the contracts and opportunities to collaborate and build relationships.
- Represent Managed Care on MOMs revenue cycle team. Responsible for meeting assigned/agreed upon goals.
- Develop and implement procedures, structure staff and systems to ensure contract compliance and track contract performance with a focus on increasing profitability and reducing cost.
- In coordination with Patient Financial Services, develop, implement and maintain unambiguous reimbursement rate structures that ensure efficient, automated billing and collections to ensure receipt of proper payment from contract payers.
- Develop in tandem with senior leadership the managed care strategy for BHC within the market. Identify opportunities to improve financial and market share performance. This position chairs or co-chairs the managed care committee and is responsible for committee agenda and schedule.
- Develop and enhance relationships with external contacts such as the broker community, various healthcare trade associations, business coalitions, governmental agencies and consultants. Represent BHCC in meetings with other organizations, associations, providers and payers regarding all aspects of managed care.
- Coordinate with Decision Support and other system and hospital departments regarding the operation and utilization of managed care related information systems (data warehouse).
- Ensure the maintenance of the managed care contract rate information, modeling, updated reports and analysis for expected reimbursement systems
- Ensure that all contracts and departmental actions follow the HIPAA regulations/guidelines.
- Is responsible for department's operational excellence; ensures department delivers quality services in accordance with applicable policies, procedures, and professional standards
- Manage team members which include orientation, development and evaluation of personnel, and monitoring the provision of delivering quality services. Participates in the recruiting, interviewing and selecting of team members following policies, guidelines and applicable laws. Evaluates their performance relative to job goals and requirements. Provides coaching to staff, recommends in-service education programs, and ensures adherence to internal policies and standards.
- Is responsible for the fiscal management of department; assures proper utilization of organization's financial resources.
- Effectively communicates departmental, organization, and industry information to staff.
Qualifications
- 7-9 years of progressive healthcare management experience with emphasis on health plan / provider contract negotiations, physician group contracting and managed care financial analysis; Experience working in both the provider / hospital and health plan settings; Successful experience working within a large, multi-level organization either in a health plan or provider; Experience working in a competitive healthcare environment required
- Bachelor's Degree in Business required
About Us
Baptist Health Care is a not-for-profit health care system committed to improving the quality of life for people and communities in northwest Florida and south Alabama. The organization includes three hospitals, four medical parks, Andrews Institute for Orthopaedic & Sports Medicine, and an extensive primary and specialty care provider network. With more than 4,000 team members, Baptist Health Care is one of the largest non-governmental employers in northwest Florida.
Baptist Health Care, Inc. is an Equal Opportunity Employer. BHC maintains and enforces a policy that prohibits discrimination against any workforce members or applicants for employment because of sex, race, age, color, disability, marital status, national origin, religion, genetic information, or other category protected by federal, state or local law.
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Baptist Health Care
Feb 11, 2025