Director of Payer Contracting & Credentialing


: $140,340.00 - $140,340.00 /year *

Employment Type

: Full-Time


: Accounting

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Omni Ophthalmic Management Consultants (OOMC) is an ophthalmic management services organization specializing in providing support to sub specialty surgical and medical eye care practices. Headquartered in Iselin, NJ, OOMC provides business services and support to wholly owned affiliated ophthalmology practices throughout the Northeast and Mid-Atlantic regions. The OOMC affiliates are optometric referral practices providing a full range of specialty services for the advanced treatment of eye diseases. The affiliate brands, by design, offer no primary care optometric services, but promote a partnership between optometry and ophthalmology to deliver exceptional vision care. While our footprint continues to expand rapidly through additional acquisitions, today our affiliates provide eye care services through a network of fifteen offices and two ophthalmology-focused ambulatory surgery centers, located throughout New Jersey, New York, Pennsylvania, and Delaware. With over 60 Board-certified ophthalmologists and residency-trained optometrists, supported by a staff of 275+ registered nurses, ophthalmic technicians, surgical technicians, and patient services representatives, OOMC supports over 200,000 patient encounters annually.. For additional information on OOMC and our affiliate providers, Omni Eye Services, Kremer Eye Center, and Phillips Eye Specialists, please visit the company websites at,,, and OOMC is currently looking for a Director of Payer Contracting & Credentialing. Reporting to the Chief Financial Officer, the Director of Payer Contracting will be responsible for the contracting, analysis, and relationship management between OOMC and its various payer constituencies and oversee the team responsible for provider credentialing. The position will be responsible for maintaining existing contracts as well as identifying new contracting opportunities in order to achieve revenue growth targets. The Director of Payer Contracting will play a key role in the design, development, negotiation and implementation of value-based, gain share, risk, and other \"future\" contracting frameworks consistent with meeting the triple aim of healthcare reform.. Analyze proposed fee schedules and negotiate financial contracts with insurance companies and other third-party payers.. Ensures internal and external compliance with all contract provisions by developing and/or using performance tracking tools (e.g., Contract Management) to gauge key performance indicators and aid in revenue cycle recoveries.. Monitors contract performance in regards to financial performance, payment integrity and value-based payment programs.. Identifies and creates processes to establish links between Contracting and other departments; develops and documents internal department's contract requirements.. Manages multiple projects and performs independently under tight deadlines with a focus on implementation, clear and consistent communication, and follow-up.. Monitors industry trends, including but not limited to the Affordable Care Act, Medicaid Expansion, payer consolidation, anticipates implications and opportunities, collaborates with colleagues to develop and manage implementation plans based upon contracting activity. Advises the senior management team on emerging trends and methodologies in managed care contracting, payer relations, and legal issues.. Understands and can articulate the business case for and/or against the financial/analytical issues, and administrative implications of contracting recommendations.. Maintains contracting calendars and/or a contract dashboard to ensure adherence to key contract dates/timelines related to contract requirements, adjustments, and/or renewals.. Manages staff responsible for credentialing and re-credentialing applications for medical providers.. Implements policies and procedures to ensure that applications are properly verified and accurately uploaded into an online credentialing database system. Responsible for ensuring providers are credentialed, appointed, and privileged with health plans, hospitals and patient care facilities.. Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications.. Analyzes and prepares reports on trends in application status. Bachelor's Degree in Health Care Administration or other applicable field. Master's degree a plus, but not required. Minimum of 8-10 years of experience in payer contracting or in a related area. Demonstrated expertise with the field's concepts, practices, and procedures. Ability to interpret contract legal language and identify significant deal points impacting the company. Strong analytical skills. Relies on extensive experience and judgement to plan and accomplish goals. Ability to successfully negotiate, build consensus, and bring deals to a close. Leads and directs the work of others. A wide degree of creativity and latitude is expected. Should be well prepared, organized and thorough with highly effective written and oral communication skills. Must possess a high level of integrity, passion and energy, an proven ability to thrive within a team environment
Associated topics: business, compliance, compliance office, corporate attorney, courtroom, internal, lawyer, legal, llp, market * The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.

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