Regional Director Managed Care
CurrentSkills: Medicare and commercial reimbursement methodologies for ambulatory surgery center and hospital outpatient prospective payment system, physician managed care reimbursement and negotiations. Payor relationship and revenue cycle issue resolution. National negotiations, onboarding communication, national contract oversightDevelop and oversee managed care strategy for each ambulatory surgery center (ASC) and hospitals across multiple states.Establish annual ASC managed care… Show more Skills: Medicare and commercial reimbursement methodologies for ambulatory surgery center and hospital outpatient prospective payment system, physician managed care reimbursement and negotiations. Payor relationship and revenue cycle issue resolution. National negotiations, onboarding communication, national contract oversightDevelop and oversee managed care strategy for each ambulatory surgery center (ASC) and hospitals across multiple states.Establish annual ASC managed care budgets.Negotiate/renew agreements with third party payers and perform financial analysis to support those negotiations.Review and negotiate contract language.Develop and maintain positive relationships with third party payers.Educate ASC internal staff on managed care issues, trends, and current managed care policies.Analyze and recommend appropriate charge master levels.Present managed care ASC-specific accomplishments and strategy to physician partners.Act as liaison for ASCs to third party payers to resolve claims and payment issues.Ensure business operations is compliant with managed care legal requirements and accurate information is memorialized to drive greater patient satisfaction. Support local legislative efforts for ASCs across multiple states. Show less
