The National Contracting Manager partners with several departments to streamline approval process to Payors within the Laboratory. This position is based in Nashville and must be local or open to self relocate to Nashville.
Reports To: CEO, Lab Operations
Develop external value proposition for national payor campaign.
Work with Marketing to develop payor specific Marketing materials.
Work with Finance to evaluate current payor reimbursement, identify "problem" payors and explore opportunities to contact differently.
Work with managed care team to assign payors per employee by location.
Work with sales to identify payor priories.
Explore new market focus on PGX and workers compensations payors, TPA's and PBM's.
Facilitates internal contracting approval process to streamline approval process. Identify Key Stakeholders.
Assist Lab Managed Care team in articulating the Addiction Labs of America's value proposition and communicates Addiction Labs of America's toxicology, specialty testing, genetics, pharmacogenetics pathology and esoteric testing offerings to health plan contracting and medical teams.
Assist in securing coverage and reimbursement for new technology and focus tests.
Work with health plans to improve coverage positions for toxicology testing.
In accordance with the Legal Team rules and procedure, responds to proposals and contracts. Negotiates pricing, execution and implementation of the contracts for selected Managed Care accounts. Assist in the review of managed care contracts from a financial and operational basis and work with division/regional operations, finance, billing, legal and business development, teams to represent all Addiction Labs of America's interests in contract negotiations.
Assist with and responsible for assigned relationships and communication with Managed Care plans. Periodic meetings with each plan as required. Quality reporting, Lab Leakage Initiatives, operational initiatives, demographic updates, new technology, etc. should be reviewed at joint operational meetings with customers.
Keep informed of developments and trends relating to all areas of the company and MCO/PPO plans.
Works with billing supervisor to communicate contract specifics for new plans and changes in data requirements for existing plans to the field.
Assists managed care coordinator/director in conjunction with legal department on all contracts.
Bachelor’s degree required.
(4+) year’s experience in managed care contracting.
Contracting experience representing labs to payers preferred.
Demonstrated knowledge of managed care, including managed Medicare and Medicaid, and other payor’s guidelines and criteria for reimbursement.
Familiar with insurance billing, coding and terminology.
Strong analytic computer and software skills.
Excellent interpersonal skills including excellent verbal and written communication skills.
Demonstrated knowledge of customer service skills when responding to questions and other inquiries from internal and external customers.
Candidates in recovery must have 2+ years of sobriety.
AAC is committed to principles of equal opportunities for all employees. The Company will provide reasonable accommodations that are necessary to comply with State and Federal disability discrimination laws.