Chapters Health

  • Director Provider Contracts-Claims Processing

    Job Locations US-FL-Temple Terrace
    Job ID
    4135 Patient Accounting
    Full Time Regular
  • Overview

    Role: Responsible for all Network Health provider contracting relationship functions including provider contract prospecting and negotiations, reimbursement and financial analysis, performance monitoring, provider compliance, service issue resolution and enhancing the brand experience with providers. Builds and manages relationships with managed care payers, with a focus on education around the Company’s value proposition and drives increased managed care penetration across the continuum of post acute care services provided the Company.



    • Associate’s degree required. Emphasis in health insurance/healthcare administration, business or related field preferred. Bachelor’s degree preferred.


    • Minimum of five (5) years healthcare experience and three plus (3+) years in healthcare managed care business and provider network development and contracting required
    • Experience in establishing and/or developing productive and creative relationships with physicians/physician groups, hospital/health system administrators, and other health care industry leaders


    • Knowledge of managed care contracting required in any of the following settings: Long Term Acute Care, Skilled Nursing/Transitional Care, Inpatient Rehab, Home Health and Hospice
    • Understanding of various payment methodologies and fee schedule administration within the hospital/outpatient, ambulatory and professional provider practice settings required
    • Ability to develop and maintain excellent working relationships
    • Customer service skills, written and verbal communication skills, interpersonal skills, ability to work independently, ability to work with a team, critical thinking, organizational skills, computer skills appropriate to the position, knowledge and competency in accounting and analysis, and knowledge of regulatory requirements appropriate for the position
    • Works under minimal supervision, exercising discretion and independent judgment to solve problems
    • Team player and self-starter who is accurate and detail oriented
    • Proficient in time management skills with the ability to prioritize a variety of duties


    Responsibilities of all employees:

    • Represent the Company professionally at all times through care delivered and/or services provided to all clients.
    • Comply with all State, federal and local government regulations, maintaining a strong position against fraud and abuse.
    • Comply with Company policies, procedures and standard practices.
    • Observe the Company's health, safety and security practices.
    • Maintain the confidentiality of patients, families, colleagues and other sensitive situations within the Company.
    • Use resources in a fiscally responsible manner.
    • Promote the Company through participation in community and professional organizations.
    • Participate proactively in improving performance at the organizational, departmental and individual levels.
    • Improve own professional knowledge and skill level.
    • Advance electronic media skills.
    • Support Company research and educational activities.
    • Share expertise with co-workers both formally and informally.
    • Participate in Quality Assessment and Performance Improvement activities as appropriate for the position.
    • Leadership Success Factors:


    • Communication. Express thoughts and ideas clearly. Adapt communication style to fit audience.
    • Initiative. Originate action to achieve goals.
    • Management Identification. Identify with and accept the problems and responsibilities of management.
    • Judgment. Make realistic decisions based on logical assumptions which reflect factual information and consideration of organizational resources.
    • Planning, Organizing and Controlling. Establish course of action for self and/or others to accomplish a specific goal; plan proper assignments of personnel and appropriate allocation of resources. Monitors results.
    • Leadership. Use appropriate interpersonal styles and methods in guiding others toward task accomplishment.
    • Work Standards. Set high goals or standards of performance for self and others. Compel others to perform
    • Tolerance for Stress. Maintain stability of performance under pressure and/or opposition.
    • Innovativeness. Generates and/or recognizes imaginative, creative solutions in work related situations.
    • Delegation. Allocate decision making and other responsibilities effectively and appropriately.
    • Staff Development. Develop the skills & competencies of subordinates.
    • Organizational Sensitivity. Perceive the impact and the implications of decisions on other components of the organization.          
    • Ethics. Model highest standards of conduct and ethical behavior, adopting a strong position against fraud and abuse.
    • Regulatory Compliance: Educate and monitor staff regarding their own and the organization's responsibilities for regulatory compliance.


    General Responsibilities:

    • Establishes and/or maintains provider network to include subsidiaries as applicable.
    • Responsible for all Managed Care contract negotiation and company managed care marketing initiatives.
    • Responsible for negotiating and renegotiating contracting for services to include but not limited to; physician/physician groups, hospital/health system administrators, nursing home, assisted living facility, diagnostic, outpatient services, ambulatory and etc.
    • Documents goals, activities and accomplishments. Communicates and prepares reports on activity, industry trends, and new business opportunities.
    • Maintains regular and open lines of communication with key and target customers for provider networking and managing close business relationships.
    • Participates in the review and evaluation of contractual arrangements and participates in negotiation of the final agreements.
    • Communicates and/or conducts in-service meetings to keep organizational staff apprised of new and /or re-negotiated managed care contracts.
    • Accesses contract performance data, identifies specific revenue enhancement opportunities, and renegotiates contracts to promote improved contract performance.
    • Responsible for the development and management of financially viable managed care contracts.
    • Maintains good rapport and cooperative working relationships with community care partners and managed care organizations.
    • Responsible for credentialing and re-credentialing to include medical staff and facility based contracted providers; handles credentialing and re-credentialing for contracted managed care organizations.





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