Director - Payer Relations and Contracting - SpecialtyCare - Nashville

Job description
SpecialtyCare is the premier clinical provider in partnering with hospitals and physicians to provide high performance patient care. SpecialtyCare offers opportunity for continuous learning, growth and career advancement.
SpecialtyCare understands our Associates’ desire to advance their careers; we offer opportunities for significant growth.
SpecialtyCare encourages our Associates to utilize our generous annual allowance for professional development to attend meetings and conferences.
SpecialtyCare offers tuition assistance to pursue additional job related college education.

Job Summary
The Director of Payer Relations and Contracting is responsible for all aspects of the Company’s relationship with commercial health insurance plans, including contract negotiation, payer contract compliance, dispute resolution, plan coverage determination updates, and credentialing. Responsible for due diligence of health plans in new markets to determine market share of health plans and benefit coverage of Company services in support of Operations and Business Development teams.
Develop and manage relationships with health plans.
Initiate and manage contract negotiations.
Monitor internal compliance of health plan contracts ensuring that rates, credentialing and other requirements of the contracts are meet by operations and billing and collections department.
Continuous review of health plan coverage determination updates.
Support Billing and Collections leadership team in resolution of health plan payment errors.
Conduct due diligence of health plans in new markets in support of Operations and Business Development teams.
Create and maintain payer contract database, keeping the information updated regularly and communicating necessary updates to appropriate individuals throughout the organization.
Communicate strategy and contracting updates to Senior and Executive leadership.
Desired Skills and Experience
Requirements
Bachelor’s degree from a four year college or university.
Minimum of three years’ experience in similar role for hospital, physician or ambulatory care provider.

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