What are the responsibilities and job description for the Director of Government Payor Contracting - Remote position at Thriveworks?
Director of Government Payor Contracting - Remote
About Thriveworks
Our mission at Thriveworks is to help people live happy, successful lives. We believe that everyone can benefit from working with a skilled and caring mental health professional. That's why Thriveworks was founded—to help those seeking counseling or coaching gain access to truly exceptional providers.
About the Job
The ideal candidate will be comfortable in a fast-paced, innovative, growing environment. You will be presented with multiple competing tasks, and no day will be the same. You will be required to bring ideas to the table and execute successfully at a rapid pace. This candidate would be responsible for the strategic development and administration of contracts with State and/or Federal governments for Medicaid, Medicare, Marketplace, and other government-sponsored programs to provide health care services to low income, uninsured, and other populations.
Key Responsibilities
- Responsible for negotiation, oversight, monitoring, and management of regulatory and contractual requirements related to government programs including, but not limited to, Medicaid, Medicare, duals (MMP), and Marketplace.
- Responsible for the strategic development and administration of contracts with State and/or Federal governments for Medicaid, Medicare, Marketplace, and other government-sponsored programs to provide health care services to low income, uninsured, and other populations
- Serves as primary internal contact for informational requests and contract interpretations.
- Perform and/or arrange for legal language review on all government program contracts prior to execution
- Oversee the implementation of new government contracts with appropriate internal departments
- Works with Billing and other internal departments to resolve moderate to complex payment and utilization issues
- Support and educate other staff regarding the interpretation, compliance, and enforcement of the contractual provisions
- Analyze impact of contract proposals
- Develop responses to state agencies as required for Medicaid and Marketplace product lines and coordinates filing process for the Marketplace line of business
- Develops, maintains and updates regulatory work plans, including state regulatory guidance documents and state rules. Educates internal staff on changes to regulatory contracts
- Develops and maintains consistent processes for all lines of business within the Payor Relations department.
Basic Qualifications
- Bachelor's Degree in Business Administration, Healthcare or related field required
- Must have min. 10 years' experience in managed care (especially Medicare, Medicaid and other State governed plans) negotiations, compliance, and implementation
- Strong payor contract negotiation skills
- Strong healthcare compliance background
- Extensive knowledge of insurance guidelines including HMO/PPO, Medicare, Medicaid, Marketplace, and other payer requirements, systems, and compliance
- Experience working in the managed care industry, particularly with health plans that contract with government-sponsored programs
- Knowledge of insurance plan benefits and terminology
- High degree of professionalism and the ability to communicate with a variety of stakeholders, including clinical team members
- Experience working with large sets of data, formula writing, pivot tables, etc.
- Strong verbal and written communication skills
- Maintains confidentiality of all patient and payor information
- Detail-oriented with strong organizational skills
- Ability to multi-task and manage competing priorities
- Persistent, able to work independently, showing initiative, while seeking guidance when appropriate
Benefits
- An amazing team culture
- Professional development & advancement opportunities
- 401K with 3% employer match
- Healthcare, Dental, Vision, and life insurance benefits
- Professional EAP program for team member & household
- Additional coverage options available such as: Short Term Disability, Long Term Disability, Group Accident Insurance
Successful Thriveworks employees believe in our mission to help people live happy, healthy lives. They also embody our core values, which focus on the ability and willingness to adapt, raise the bar, act with integrity, achieve our goals, and work well together. If you think you fit the bill and belong on our team, apply today!
