Senior Director of Market Access, Payor Strategy, and Contracting
General Information
City: California
Team: Finance
Working Time: Full-Time
Description & Requirements
Company Description
Intercare Therapy, Inc. (ICT) provides evidence‐based behavior services that support individuals with autism and related disorders and their families. Our mission is to increase independence and improve the quality of life of our client families. As an organization, we strive to be:
- The employer of choice for all staff, by providing a long-term career opportunity, supportive and collaborative organizational culture, and fulfilling individualized professional experience and development.
- The preferred service provider to our clients, families and funding sources, providing high quality clinical care and high‐touch customer service.
Position Overview
The Senior Director of Market Access, Payor Strategy, and Contracting is a key leadership role reporting directly to the Senior Vice President of Finance & Operations. This position is responsible for developing and executing strategies to ensure Intercare Therapy's services are accessible to clients and their families across the nation via payor contracting and relationship management. The role involves partnership with Finance, Operations, and Compliance functions across the Intercare organization as well as the Executive Leadership Team (ELT) with regards to growth strategy and rate negotiation. The ideal candidate will be a high-impact individual who can work cross-functionally possessing deep expertise in the payer environment, particularly within the behavioral health industry.
Key Responsibilities
Contracting & Negotiations
- Develop and implement market access strategies for Intercare Therapy's service portfolio.
- Lead negotiations for favorable contractual terms for Intercare Therapy.
- Prepare and implement annual contracting plans.
- Participate in the development of new business programs/ventures that include new payment arrangements with third-party payers and employers.
Contract Management & Payer Compliance
- Design and execute short, mid, and long-term reimbursement strategies to support business growth.
- Develop and maintain systems for oversight and monitoring of payer and staff compliance with contracts.
- Provide oversight and direct leadership of payer operational meetings and escalate disputes related to payer policies and material claims disputes.
- Ensure compliance with contract terms, pricing agreements, and regulatory requirements.
Payer Relations
- Build and maintain relationships with key stakeholders, including insurance providers, school districts, and other funding sources.
- Develop and maintain appropriate working relationships with decision-makers in third-party payers, insurance companies, employers, and government entities.
- Conduct presentations and market Intercare Therapy to third-party payers, government officials, and employers.
Data Analysis & Pricing
- Conduct in-depth market research and analysis to understand industry trends, payer requirements, and competitive dynamics.
- Develop analytical reports to demonstrate the financial impact of current and proposed arrangements for contracts.
- Review all contract fee schedules annually for appropriate maintenance and compliance.
- Recommend annual fee schedule changes and pricing policies.
Additional Responsibilities
- Support the ELT in organization-wide project management and prioritization of business initiatives.
- Support in development of the steps required for Intercare Therapy's expansion into new states.
- Lead the development of tools to model contracts and monitor payor performance.
- Communicate changes in payer policies and contract terms to stakeholders company-wide.
Qualifications and Skills
Required:
- Bachelor's degree in Healthcare Administration, Business, Economics, or a related field.
- 7+ years of work experience in healthcare, contracting, or a related job discipline.
- Strong knowledge of healthcare reimbursement systems, coding principles, and billing regulations.
- Excellent communication, negotiation, and interpersonal skills.
- Strong analytical and problem-solving skills, with experience in market research and data analysis.
- Ability to work independently and make priority determinations without direct supervision.
Preferred:
- Master's degree (MBA or MHA).
- Healthcare contracting experience.
- Negotiation experience (contracts).
- Experience reviewing payer policies.
- Experience with project management, workflow management, and EMR systems used in contract and revenue cycle management.
- Ability to thrive in a fast-paced, dynamic environment, remaining focused and composed in stressful situations.
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