Director, Managed Care - Contracts

Acadia Healthcare•Franklin, TN

About The Position

Acadia Healthcare’s purpose is to Lead Care With Light and our mission is to be a world-class organization that sets the standard for excellence in the treatment of mental health and addiction concerns. We strive to maintain our standing as a thought leader in the behavioral healthcare industry, providing treatment that is synonymous with compassion and innovation. The Director of Managed Care Contracts is responsible for providing oversight to Corporate Manager(s) of Managed Care assigned. Provides leadership level support and guidance to facilities in the areas of managed care contracting, managed care relationships, developing an infrastructure to support managed care business, payor mix, and contract operations. Assists in the development of contracting initiatives, to include preparing facilities for Value Based Contracting. Evaluates reimbursement rates and methodology to result in a net revenue growth. Establishes departmental Key Performance Indicators and reporting practices to improve team efficiencies.

Requirements

Bachelor’s degree in business or healthcare related field.
Minimum 5 years’ contract experience in a health care facility/system or managed care organization, including previous Behavioral healthcare experience.
Knowledge of laws, regulations and rules related to managed care.
Knowledge of major payors, reimbursement, and value based contracting models.
Effective and accurate oral and written communication skills. Ability to communicate interdepartmentally to include Business Office, UM, Clinical, Finance Operations, Compliance, Legal, and Senior Leaders.

Responsibilities

Leads the team with focus on the Vice President’s vision and embeds organization’s strategic goals into team’s daily practice and culture.
Serves as the primary people leader directly responsible for day-to-day management and oversight of Corporate Managers of Managed Care and indirectly responsible for all managed care contracting and relationships related to the support of Acadia facilities, as referenced below. Evaluates staff’s assigned facility caseloads throughout the year and adjusts as necessary.
Assists facilities in managed care contracting and revenue enhancement strategies for their area.
Uses data to determine areas where rates can be potentially improved. Combines data from surrounding areas to create regional or service-line multi-facility negotiation opportunities.
Review rates and renewal dates to ensure contracts are negotiated timely and that rate requests are appropriate. Owns negotiation, when appropriate. Overall, keeps track of time, pace, and success level of important contract negotiations.
Provides regional and large-scale guidance to facilities regarding development of managed care relationships and rate negotiation. Reviews data to develop regional and/or national contracting opportunities.
Assists facilities with ensuring managed care contracts are acceptable according to organization’s required standards, and is responsible for approving pre-screened managed care contracts in organization’s contract management software. Assists in execution and implementation of contract changes, as needed.
Oversees contracting process for startup facilities and facilities who change from a self-pay model to a more diversified business model. Collaborates with Vice President of Managed Care to develop start-up facility managed care strategy, rate parameters, and targeted payor listing.
Provides guidance on payor-related documents and forms needed for network participation and advises on making changes to network status including but not limited to: services offered, locations, professional reimbursement, and participating products.
Assists facilities with issues with major payors such as contract disputes and denials.
Work with facilities to monitor the impact of specific managed care strategies and contracts. Evaluates opportunities to grow net revenue by contracting or terminating contracts with managed care payors.
Assist business development staff with overall strategies to ensure volume growth in key payors and a balanced payor mix.
Provide ongoing training to the department on-site or via regularly scheduled conference calls.
Works with Vice President of Managed Care to maintain current knowledge of managed care trends and changes and ensures facilities are prepared and compliant.
Works with division and senior leadership and Corporate UM/Intake/Business Office staff to ensure payer related challenges and opportunities are dealt with collaboratively for resolution.
Surveys managed care organization’s needs and assists in evaluating as a potential growth opportunities for facilities or the Acadia enterprise.
Performs other duties as assigned.
Complies with organizational policies, procedures, performance improvement initiatives and maintains organizational and industry policies regarding confidentiality.
Communicate clearly and effectively to person(s) receiving services and their family members, guests and other members of the health care team.
Develops constructive and cooperative working relationships with others and maintains them over time.
Encourages and builds mutual trust, respect and cooperation among team members.
Maintains regular and predictable attendance.