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Director, Payer Contracting

Company: Children's Dental Management
Location: West Chester
Posted on: January 16, 2022

Job Description:

Children's Dental Management, the region's leading provider of pediatric dental care, is seeking a Director, Payer Contracting, at our headquarters in West Chester, PA!
The Director, Payer Contracting is responsible for the management and oversight of all aspects related to payer contracts and credentialing for the company in all states. This position secures and maintains all payer contracts, including those associated with future growth. This position also manages a team that supports the organization by maintaining appropriate credentialing with the various insurance companies, and also for our internal credentialing of providers for the surgery centers.
Children's Dental Management is the leading pediatric dental support organization in the Mid-Atlantic region. CDH currently operates 30 practice locations and five surgery centers in the Pennsylvania, New Jersey, and Delaware marketplace. CDH Management has an outstanding clinical reputation serving the unique needs of all children, while positioning itself to grow into a multi-state, multi-discipline provider to the pediatric community.
We are pleased to offer a competitive salary and strong benefits package, which includes:

  • Medical/Dental/Vision Insurance
  • Company-paid dental coverage
  • 401(k) with company matching
  • Generous paid time off (PTO) policy
  • Company paid holidays
  • Employer-paid Group Term Life Insurance, Short-Term Disability, and Long-Term Disability Insurance
    Essential Functions:
    • Negotiate and manage payer contracts across the organization, including all lines of business.
    • Develop and execute renegotiation strategies and plans for existing contracts.
    • Develop value-based agreements with payers, as needed.
    • Manage the credentialing and contracting teams.
    • Utilize tools, such as checklists and Credential My Doctor to manage workflows and deadlines associated with credentialing. Maintain the tools so that all information is current and accurate.
    • Influence and educate various external and internal business partners on contracting strategies, marketplace dynamics, patient healthcare trends, and payer mix considerations.
    • Utilize knowledge of contracting and negotiating to develop and communicate payer contract execution strategies.
    • Demonstrate management presence (confidence, credibility, and capability), providing strategic input to and/or seeking advice from senior leaders internally and externally on a variety of topics related to payer contracts.
    • Value and develop relationships with leaders of payers and managed care organizations within current regions, and future states/regions where the company plans to grow.
    • Analyze and recommend resolutions of contract barriers, taking into account prevailing local market information.
    • Evaluates staffing needs to support the current and future state of the organization as it relates to credentialing and contracting.
    • Research new technology/software to more effectively manage contracting and credentialing initiatives and tasks.
    • Train and develop staff.
    • Meet with staff regularly to monitor status of work, set goals, provide feedback, etc.
    • Communicates updates for credentialing & payer contracting effectively.
    • Manage and maintain payer contracting fee schedules.
    • Collaborate with other departments as needed, especially Finance and Revenue Cycle Management (RCM).
    • Assist RCM with claims issues, when relating to contract terms, by facilitating and interfacing with the payer's key contacts who manage the contracts.
      • 5+ years' management experience in healthcare contracting/credentialing.
      • Excellent written and verbal communication skills.
      • Well-developed conceptual and integrative thinking with capability to access internal and external resources for advice.
      • Ability to implement projects, including engagement with key stakeholders, with high degree of autonomy.
      • Ability to work collaboratively across multiple departments internally, and with external payers/partners and vendors.
      • Bachelor's degree.

Keywords: Children's Dental Management, Wilmington , Director, Payer Contracting, Executive , West Chester, Delaware

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