Director of Payer Conformance

Revenue Cycle Analyst

About The Organization

SaVida Health, a private equity backed healthcare company, provides outpatient opiate and alcohol addiction treatment services. SaVida Health's care model includes medical care, counseling, comprehensive toxicology testing, case management and medical management of psychiatric medications. SaVida is headquartered in Nashville, TN and currently operates in Tennessee, Massachusetts, New Hampshire, Delaware, Vermont, Maine and Virginia and is developing the capability to expand rapidly to meet the needs of patients suffering from opiate and alcohol addiction.

Job Description

This role’s primary focus is to work diligently to ensure optimal reimbursement for services as it relates to payer contracts and operations. This position is responsible for administrative, strategic, business development, and contracting activities related to the medical insurance payer environment.

Role And Responsibilities

• Periodically assess local and global market reimbursement rates for clinical procedures and services. Develop and communicate with executive leadership team, payer specific analytics and reports on a regular basis.
• Develop strategies and action plan to implement opportunities for rate improvements.
• Monitor payer contract conformance and address any issues of misconduct.
• Calculate and maintain revenue fee schedules in Athenahealth.
• Monitor relevant practice specific payer trends and compare to global and/or market trends.
• Advise leadership on reimbursement risks as it relates to specific procedures and codes. Act as an internal resource in interpreting payer contracts.
• Manage contracting and payer relations to include contracting activities such as focusing on rate strategies, maintaining strategic internal and external relationships, evaluating contracts and related contractual relationships.
• Direct Credentialing team to support clinic and provider expansion.
• Negotiate contract renewal terms and develop and implement new contracts based on contract goals and parameters. Create and implement new rate structures that enhance reimbursement when appropriate.
• Lead proactive contract renewal by working closely with operations, revenue cycle and finance leadership to develop contract proposals based defined strategies, goals, and objectives.
• Provide payer consulting and leadership relative to business direction, strategy and network positioning as they relate to payer reimbursements.
• Disseminate relevant contract details to all relevant departments (such as patient access, registration, business office, finance, practice operations etc.) to facilitate contract administration and execution.
• Support clinic and admin departments in understanding operational issues as they relate to specific contracts and patient populations (e.g., payer portals, collections, prior authorizations, referrals, etc.)
• Direct the preparation and distribution of payer reporting for senior leadership demonstrating financial analysis of current and proposed contract performance and utilization.
• Provide input to finance department with respect to contract performance analysis and monitoring
• Support payer strategy and contracting activities related to special projects, including new practice acquisitions and addition of new services.
• Provide leadership and support to payer issues and escalations meetings and develop and maintain appropriate relations with managed care payers.
• Oversee assigned revenue cycle and credentialing staff.
  
  
  

Qualifications And Education Requirements

• Bachelor’s degree in business, healthcare administration, or other related field required
• 5 + years’ experience in a contracting related field within a community physician office environment preferably SUD or a behavioral health related entity
  
  
  

Preferred Skills

• Must possess experience with negotiating managed care/health plan contracts, administering and implementation of contracts.
• Must have experience with facilitating billing and claims issues attributed to payer contracts
• Demonstrate a high level of knowledge of health care delivery systems, the local and national health care environment
• Ability to determine appropriate course of action in complex situations
• Outstanding organizational and time management skills
• Excellent interpersonal and leadership skills
• Great communication and presentation skills
• Problem-solving mindset
• Strong HER reporting skills; previous experience with Athenahealth a plus
• Excellent attention to detail
• Strong analytical skills
• Ability to travel as needed
  
  
  

EOE STATEMENT

We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability status, protected veteran status or any other characteristic protected by law.