Job Title: Director, Managed & Revenue Cycle Management

Functional Unit: Finance

Group: Fiscal

Status: Full-time, Mon - Friday

FLSA Classification: Exempt

Reports to: Chief Financial Officer

Job Location: Brooklyn & Manhattan

Direct Reports: Revenue Cycle Manager 7 revenue Cycle Specialist

POSITION SUMMARY

This position coordinates the agency’s efforts to develop and maintain relationships with Managed Care Plans, Commercial Plans, Medicaid, and Medicare (collectively referred to as “Payers”), and other entities like Skilled Nursing Facilities, Residential facilities, etc. s involved in the coordination of behavioral health and medical care. A major focus is to enhance the education of these external stakeholders about the value of START’s comprehensive spectrum of services.

Congruent with this focus are the efforts at resolving any conflicts in the provision of care and ensuring appropriate billing and payment for services rendered. To perform this job successfully, an individual must be able to develop, manage and sustain network relationships with Payers and negotiate sound contracts that optimize START’s revenue, margin, and growth goals. Candidate must have knowledge of the scope of services requested by managed care organizations, and commercial plans, and rely on extensive experience and judgment to plan and accomplish goals.

The role must immediately report any violations (alleged or otherwise) of confidentiality or privacy or any physical or other harm to the adolescents served or the staff providing such care.

ESSENTIAL FUNCTIONS

Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

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  Maintains relationships and resolves clinical and operational issues, as well as billing related matters with Medicaid, Medicare, contracted managed care organizations and commercial plans (or at times Health Homes) by acting as liaison with Managed Care Organization Provider Relations staff and Health Home representatives.
• Manage revenue cycle process together with the Revenue Cycle Manager, Revenue Cycle Specialist and external billing company.
• Optimize workflows to address billing issues through process management
• Create strategies to identify root cause of billing and coding issues
• Monitors all policy and regulatory requirements of New York State agencies including, but not limited to the Department of Health (“DOH”),Office of Addiction Services and Supports (“OASAS”), Office of Mental Health (“OMH”), and Office of Inspector General (“OMIG”), related to the operation of Medicaid managed care and provides management and operational staff relevant information on a timely basis
• Develops the local Market Managed Care Strategy and manages all aspects of assigned managed care payer relationships, including: (i) identifying demand and scheduling meetings with the relevant payer contacts; (ii) creating tailored presentations / educational materials; (iii) seeking preparation and attendance support from appropriate colleagues based on the agenda; (iv) facilitating meetings.
• Sponsors (ideally) quarterly meetings with assigned managed care payers to identify and discuss strategies to resolve key clinical and operational issues, including: (i) coordinating with the payer to prepare the agenda; (ii) inviting the appropriate START stakeholders; (iii) preparing the necessary materials in support of the agenda; (iv) facilitating meetings.
• Sponsors monthly cross-departmental, cross-functional Managed Care Meetings (which will serve a forum for communication between internal and external stakeholders), to assist with compilation of required data and analysis.
• Provides data to Management on relevant elements of new or renegotiated contracts, including preparation of training materials.
• Documents critical reporting capabilities for START based on Payers’ evolving data needs.
• Attend local and national conferences, as relevant.
• Document goals, activities and accomplishments. Communicates and prepares reports on activity, industry trends, new business opportunities, statistical information/market share and other data as required by the agency’s leadership team.
• Serves as a standing member of START’s Continuous Quality Improvement Committee.
• Maintains close involvement and active membership with Case Management Society of America, COMPA, American Public Health Association (APHA), and other relevant organizations/associations.
• Accountable to maintain the confidentiality of patient-related information.
• Accountable to abide by all relevant institutional, departmental, and program policies and procedures and state and federal laws.

REQUIRED QUALIFICATIONS & COMPETENCIES

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  Master’s degree in business or health care administration required.
• JDs’s with contract experience are welcomed to apply.
• 5+ years of healthcare experience with 3 years of direct involvement with managed care.
• Minimum of 2 years of managed care contract experience.
• Knowledge of the field of behavioral health and primary care is preferred.
• Billing compliance experience is a plus
• CPC or other professional certification a plus
• Self-motivated and results oriented.
• Strong organizational and interpersonal skills, including the ability to work collaboratively with various
• colleagues to achieve defined market-specific goals.
• Ability to apply knowledge of clinical terminology and payer reimbursement methodologies, including managed care payer requirements.
• Understanding of contract language.
• Ability to effectively communicate in English in verbal, written, and presentation format.
• Ability to work under stress and meet deadlines.
• Proficiency in computer applications, including Microsoft Office, and ability master the programs used as START within days of employment.

SUPERVISORY RESPONSIBILITIES

The Patient Access Manager supervises the Central Intake Coordinators and the Medicaid Service Coordinators.

WORK ENVIRONMENT

Standard office setting with dedicated office space.

PHYSICAL DEMANDS

The following physical demands are representative of the physical requirements necessary for the General Counsel to be successful at performing the essential functions of the role. Reasonable accommodation can be made to enable people with disabilities to perform the described essential functions of the position.

While performing the responsibilities of the job, the employee is required to talk and hear. The employee is often required to sit and use his or her hands and fingers, to handle or feel. The employee is occasionally required to stand, walk, reach with arms and hands, climb or balance, and to stoop, kneel, crouch or crawl. Vision abilities required by this job include close vision usage via computers, reviewing legal documents and reports, and creation of correspondence documents as needed.

Benefits

• Vacation, personal, and sick leave
• Medical, dental, vision plans
• Pension & retirement plan
• Short & long-term disability
• Life insurance
• AFLAC
• Pet Insurance

Student Loan Forgiveness Programs

• Public Service Loan Forgiveness
• National Health Service Corp Loan Repayment

Limitations and Disclaimer

The above job description is meant to describe the general nature and level of work being performed; it is not intended to be construed as an exhaustive list of all responsibilities, duties and skills required for the position.

START is an equal-opportunity employer. We value a diverse workforce and an inclusive culture. START encourages applications from all qualified individuals without regard to race, color, religion, gender, sexual orientation, gender identity or expression, age, national origin, marital status, citizenship, disability, and veteran status.

START undertakes affirmative action strategies in its recruitment and employment efforts to assure that persons with disabilities have full opportunities for employment in all positions.

We encourage applicants with disabilities who may need accommodations in the application process to contact: engagement at startny.org ~Correspondence sent to this email address that is not related to requests for accommodations will not be reviewed. Applicants should follow the instructions above regarding how to apply.