Responsible for agency-wide network development and management. This position contributes to the development of the network strategic direction and is accountable for the management of provider relations and payor contracting. This position will interact with the Chief Executive Officer (CEO), Medical Director, Executive Leadership Team (ELT), Chief Financial Officer (CFO), and Director of Managed Care.
Responsible for the development and management of payor networks for all products.
Responsible for interpreting and analyzing contracts to present to ELT members.
Manages increasingly complex revenue contracts and negotiates fee-for-service and sophisticated value-based reimbursements with a variety of payer sources, including but not limited to managed care organizations and third-party payers.
Develops evaluation criteria and monitoring plans for contracts post implementation.
Develops, maintains, and communicates contract workflows.
Develop, maintain, and communicate contract risk assessments.
Participates in the creation and implementation of departmental strategies, operational procedures, policy development, and budget development as appropriate and requested by Chief.
Support continuous quality improvement of departmental operations.
Oversee contracts team to include MHMR provider relations.
Ensures department staff remain current in all aspects of Federal and State rules, regulations, policies and procedures and creates or modifies departmental policies to reflect changes.
Partner with Patient Financial Services (PFS) on the implementation of electronic strategies for payor network to include increasing electronic claims submission and implementation of improved processes that result in increased auto-adjudication of claims.
Ensures payor contracting policies are adhered to as related to standard contract language.
Ensures that non-standard contract elements are communicated to appropriate departments and obtains MMHR approval prior to submission to payor.
Responsible for compliance with network adequacy standards.
Ensures the payor network meets the needs of MHMR individuals served.
Establishes a recruitment plan, conducts recruiting activities and oversees the recruitment efforts of staff.
Responsible for departmental staffing decisions and provides supervision to assigned staff, writes and performs annual reviews and monitors performance issues as they arise.
Leads team in a manner conducive to ongoing growth and expanded knowledge of payor contracts and provider relations.
Coach team members in the use of data and appropriate analytical tools that support improved quality.
Support team members in the identification and creative problem resolution for improved processes and expanded use of technology.
Support collaborative team efforts that produce effective working relationships and trust.
Systematically keeps staff informed of policy and procedural changes affecting program and administrative operations.
Coordinates with the Revenue Cycle Management (RCM) team to:
Ensure compliance with costing guidelines established by MMHR.
Ensure payor contracting is consistent with claim payment methodologies.
Maintain familiarity with Medicaid and MCO fee schedules and reimbursement methodologies.
Comply with established contract implementation process(s) for all contracts.
Functions as the liaison with the payors and the MHMR RCM team.
Ensure payor rosters are monitored and strategies are developed, and plans are implemented to address outliers.
Is an active member of the RCM meetings and RCM divisional activities.
Develops and ensures compliance of department budget.
Participates in committees as appropriate to include the credentialing committee.
Performs other related duties and projects as assigned.
Adheres to MMHR policies and procedures.
Supports and carries out the MMHR Mission & Values.
Internal & External Customer Service
This position requires extensive internal and external contacts. The employee will accomplish this with advanced written and verbal skills as well as via electronic communication.
The position will have high travel to other sites to interact with managers and/or directors.
Laptop, desktop computer and accessories; Calculator; Copier; Digital Cameras; Paper Shredder; Recorders; Fax; Printer; Portable Projector and conference room equipment; Car (personal and/or agency)
This position may require temporary or permanent re-assignment to any MHMR Tarrant office, location, or facility as determined by program needs or the Division Director.
Assigned work hours may change as the needs of the agency change.
The Functional Title of this position may change as the needs of the agency change.
All work will be completed within the scheduled work hours. No work is done off the clock.
Prior approval from supervisor is required for all paid time off (PTO) and overtime.
Agency dress code is to be followed at all times.
Minimum Job Qualification Requirements:
Education: Bachelor’s degree
Defined Education: Business or Health related disciplines such as Healthcare Administration or Healthcare management or equivalent business experience.
Years of Experience: 2
Supervisory Experience: 2
Internal Number: 3082
About MHMR of Tarrant County
My Health My Resources (MHMR): We Change Lives For nearly 50 years, MHMR has provided community-based services for youth and adults with intellectual and developmental disabilities (IDD), mental health conditions, and substance use disorders, as well as babies and young children with developmental delays. MHMR employees use a person-centered approach to fulfill the mission: WE CHANGE LIVES! Using innovative approaches, MHMR partners with community organizations to provide services and a hopeful future.