Student Veterans of America Jobs

Welcome to SVA’s jobs portal, your one-stop shop for finding the most up to date source of employment opportunities. We have partnered with the National Labor Exchange to provide you this information. You may be looking for part-time employment to supplement your income while you are in school. You might be looking for an internship to add experience to your resume. And you may be completing your training ready to start a new career. This site has all of those types of jobs.

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Job Information

Wellpath Senior Director of Payer Contracting in Nashville, Tennessee

Why Wellpath

Here at Wellpath, everything that we do is about taking care of people – our patients, our staff and our partners. We are committed to making a difference by providing hope and healing to vulnerable patients in challenging clinical environments. Our talented, compassionate team thrives in an autonomous environment, is empowered and supported by education, training and the resources to practice healthcare the way it is meant to be and strives to “Always Do The Right Thing!”

About this role

The Senior Director of Payer Contracting is responsible for developing and operating new Payer Contracting role under network development to assist the Community Care Clinics division.

What you bring to the table

Education:

  • Bachelor’s degree in related field or equivalent experience

Experience:

  • 15+ years of Managed Care/Healthcare contracting experience with 10+ years of experience working with Provider Enrollment, Payer reimbursement methods.

  • 10+ years of experience in obtaining and managing government contracts (Medicaid, Medicare, Tricare etc.)

Licenses/Certifications:

  • None required.

What you will do

  • Develops and continually optimizes the payer network.

  • Manage Multiple clinic contracts in a growing division in multiple states

  • Setting Managed Care contract targets in line with financial and strategic objectives and goals

  • Negotiating new and renewal contracts on a timely basis

  • Management of provider enrollment processes and requirements for commercial insurance companies, CMS Federal and State Guidelines related to enrollment and reenrollment policies required.

  • Knowledge of insurance payer processes, local, state, and federal requirements

  • Demonstrate understanding of reimbursements following Centers for Medicare and Medicaid payment models, as well as industry standard managed care terms and conditions

  • Manage Contract Files and ensure all items are filed correctly. Ensuring all documents associated with the negotiated payer Agreement are in the systems correctly at all times.

  • Ensure documentation and all negotiated Agreements are updated in SharePoint and reflect current Agreement terms and status.

  • Build and maintain professional and productive relationships with internal teams and external contracted payers

  • Understand and communicate contract specific issues for all payers.

  • Provide other reports as directed by -management

  • Follow-Up with payers for status information as requested.

  • Audit billing information following effective date to ensure terms are loaded and reimbursement is aligned with contracted terms.

  • Perform other duties as assigned

Wellpath is an EOE/Minorities/Females/Vet/Disability Employer

Our investment in you

  • Medical, Dental and Vision Insurance plan options

  • Time off & leave benefits

  • 401K

  • Tuition Reimbursement

  • Parental benefits

  • Perks and discounts

  • And more available herehttps://wellpathcareers.com/ (https://wellpathcareers.com/#rewards)

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Job 21-97855

Facility Wellpath East Network Development/Claims

Type Full-Time

Shift Day 8 hour

Recruiter Rankin Holloway

Email RHolloway@Wellpath.us

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