Byram Healthcare Director, Managed Care (Chicago, IL) in Chicago, IL at Byram Healthcare

Date Posted: 7/9/2018

Job Snapshot

Job Description

POSITION SUMMARY

 

Drives revenue and gross margin.  Is a pro at payer relationships, network management, and all things contracting.

ESSENTIAL JOB FUNCTIONS: 

1.      Contacts key payers, via phone or in-person, to deliver value propositions and drive narrowed results.

2.      Manages network related issues including member grievances, authorization issues and missed orders.

3.      Completes in-person in-services for UM teams.

4.      Reviews daily revenue and GM% reports.

5.      Updates Customer Management Resource (CRM) system with appointments and contacts.

6.      Works with your local Account Manager on calls with physicians, Independent Practice Association (IPA)'s hospitals, clinics and home health agencies.

7.      Submits price increases to key managed care accounts.

SUPPLEMENTAL JOB FUNCTIONS:  

  • Performs additional duties as directed.


Qualifications

EDUCATION & EXPERIENCE REQUIRED:  

  • Bachelor's Degree required, MBA a plus
  • Must have existing, strong Payer Relationships in the assigned market
  • Must have proven success driving revenue & GM%

KNOWLEDGE SKILLS & ABILITIES:

  • Must know Managed Care Model including:  IPA's, Medical Groups, MSO's, Health Systems and Health Plans, DOFR, Medicare and Commercial Fee Schedules
  • Must understand contracting including:  financial analysis, credentialing, legal review, implementation, preferred, CAP, Value-base and utilization data
  • Must understand network management including:  grievance resolution, authorizations and resolving complex member-level issues
  • Excellent communication, presentation and negotiation skills
  • The ability to work with and influence others including:  customer service, revenue cycle, distribution, manufactures and key strategic partners
  • Strong work ethic, integrity and accountability


ADDITIONAL REQUIREMENTS:

  • None

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