Wellpath Senior Director of Payer Contracting in Nashville, Tennessee
Here at Wellpath, everything that we do is about taking care of people – our patients, our staff and our partners. We are committed to making a difference by providing hope and healing to vulnerable patients in challenging clinical environments. Our talented, compassionate team thrives in an autonomous environment, is empowered and supported by education, training and the resources to practice healthcare the way it is meant to be and strives to “Always Do The Right Thing!”
About this role
The Senior Director of Payer Contracting is responsible for developing and operating new Payer Contracting role under network development to assist the Community Care Clinics division.
What you bring to the table
- Bachelor’s degree in related field or equivalent experience
15+ years of Managed Care/Healthcare contracting experience with 10+ years of experience working with Provider Enrollment, Payer reimbursement methods.
10+ years of experience in obtaining and managing government contracts (Medicaid, Medicare, Tricare etc.)
- None required.
What you will do
Develops and continually optimizes the payer network.
Manage Multiple clinic contracts in a growing division in multiple states
Setting Managed Care contract targets in line with financial and strategic objectives and goals
Negotiating new and renewal contracts on a timely basis
Management of provider enrollment processes and requirements for commercial insurance companies, CMS Federal and State Guidelines related to enrollment and reenrollment policies required.
Knowledge of insurance payer processes, local, state, and federal requirements
Demonstrate understanding of reimbursements following Centers for Medicare and Medicaid payment models, as well as industry standard managed care terms and conditions
Manage Contract Files and ensure all items are filed correctly. Ensuring all documents associated with the negotiated payer Agreement are in the systems correctly at all times.
Ensure documentation and all negotiated Agreements are updated in SharePoint and reflect current Agreement terms and status.
Build and maintain professional and productive relationships with internal teams and external contracted payers
Understand and communicate contract specific issues for all payers.
Provide other reports as directed by -management
Follow-Up with payers for status information as requested.
Audit billing information following effective date to ensure terms are loaded and reimbursement is aligned with contracted terms.
Perform other duties as assigned
Wellpath is an EOE/Minorities/Females/Vet/Disability Employer
Our investment in you
Medical, Dental and Vision Insurance plan options
Time off & leave benefits
Perks and discounts
And more available herehttps://wellpathcareers.com/ (https://wellpathcareers.com/#rewards)
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Facility Wellpath East Network Development/Claims
Shift Day 8 hour
Recruiter Rankin Holloway
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