Outpatient Therapy Contractor/Payor Relations Manager

About the Company:
Ensign Services, Inc. ("ESI") is a subsidiary of The Ensign Group, Inc. whose affiliated entities are considered national leaders in the fast-growing post-acute care industry. ESI provides service and support to over 280 facilities in the long term care continuum that employ over 35,000 employees.
ESI is known as the "Service Center" and provides the facilities and leaders it serves with "back-office" support in areas such as accounting, construction, compliance, human resources, information technology, learning and development, legal and risk management and recruiting. This structure allows the onsite leaders and caregivers to focus on day-to-day care and operational issues in their individual operations. What sets ESI apart from other companies is the quality of our most valuable resource - our people.
We take our core values of Celebration, Accountability, Passion for Learning, Love One Another, Intelligent Risk Taking, Customer Second, and Ownership ("CAPLICO") seriously. We want an individual in this role who will demonstrate these values through actions and words.
About the Opportunity:
To establish, implement, and evaluate the strategic plan(s) for all Payor types (including but not limited to Medicare B, Medicaid, Managed Medicaid, Managed Care, Worker's Comp and Value Based contracting and partnership opportunities) that will ensure each Outpatient Therapy operation ( Part B/Outpatient Community SNF based and freestanding Outpatient Therapy clinic settings) to build preferred provider partnerships with external partners (i.e. Healthplan, Managed Care delegated entities ( ACOs, IPAs) and Value Based entities in order to optimize financial performance and market share growth..
To actively live our Core Values in the daily performance of your job. The Core Values are: CELEBRATION, ACCOUNTABILITY, PASSION FOR LEARNING, LOVE ONE ANOTHER, INTELLIGENT RISK TAKING, CUSTOMER SECOND AND OWNERSHIP.
ESSENTIAL JOB DUTIES:
Every effort has been made to identify the essential functions of this position. However, it in no way states or implies that these are the only duties you will be required to perform. The omission of specific statements of duties does not exclude them from the position if the work is similar, related, or is an essential function of the position.
DUTIES AND RESPONSIBILITIES:

• Adheres to and assures compliance with Code of Conduct, facility policies and procedures and all applicable rules, regulations and standards as promulgated by Federal, State, and accrediting agencies or regulating bodies. This includes, but is not limited to, Department of Health, Centers of Medicare and Medicaid Services, and other applicable regulatory agencies.
• Establish, implement, and evaluate the strategic plan(s) that will ensure each local operation the ability to optimize financial performance through rates and increased census
• In conjunction with SNF Managed Care Resources, engage in complex levels of contract development and negotiation, including risk agreements with all payor types (including but not limited to CMS, State Medicaid, Managed Care Healthplans and delegates, Value based organizations including but not limited to ACOs and IPAs for Part B/Outpatient Therapy services.
• Identify, develop, and maintain an effective relationship with contracted health plans and managed care and Federal and State regulatory agencies. Facilitate with Operations and IDT Joint Operating Committee collaboration meetings
• Serve as a Subject Matter Expert (SME) for all items related to Outpatient Therapy and Part B services and ensure collaboration between all Continuum of Care partners for success in collaborative financial and clinical goals.
• Actively draft, review, and negotiate contract language and reimbursement on behalf of the freestanding Outpatient Therapy clinics as well as work in conjunction with SNF MC Resources regarding SNF based Part B outpatient custodial services and Outpatient Community Therapy service operated under the auspices of the respective Skilled Nursing Facility. Work in collaboration with SNF Managed Care Contractor.
• Lead analysis and coordination of amendments, reimbursement, and language changes
• Assess resource utilization, cost management, and negotiate effectively.
• Monitor industry changes, trends, and events to proactively identify opportunities to increase market penetration and performance improvement.
• Understands the competitive pricing levels in the local market and improved the company's cost position through unit costs strategies.
• Strategizes for Outpatient Therapy census growth.
• Educate and Multiple facility and clinic IDT and Service Center staff and Resources on how to operationalize the contract and ensure collaborative and joint training with Resource partners including training and coaching staff responsible for managed care prior authorization, case management, discharge planning and any other related oversight for any payor type.
• Work in collaboration with the dedicated outpatient Prior Auth Specialists as well as facility/clinic staff responsible for benefit verification, prior auth, case management, discharge planning, coordination with upstream and downstream clinical and payor partners to assist in operationalizing the contracts
• Analyze, create and implement efficient workflow practices for operational success with all Outpatient Therapy services in collaboration with operations and resource partners.
• Proactive communication to the Operations and Service Center on new contracts, amendments and changes shared by the specific Healthplan or delegated Managed Care Contract partners (ACOs, IPAs, VBP, etc.) for the Facility and supporting Market Resources to optimize contract terms and conditions.
• Responsible for completing and tracking all Outpatient Therapy credentialing applications for therapists and facility/clinic settings

KNOWLEDGE, SKILLS & ABILITIES:

• Outpatient Therapy Contracting proven track record all service locations.
• Knowledge of managed care contracting language, requirements, and methods to support the development and maintenance of contract compliance, contract language review and contract analysis.
• Be knowledgeable about the managed care environment; including Lines of Business (LOB) including but not limited to Medical Advantage, Commercial, Exchange, Managed Medicaid Dual, and Special Needs plans as well as familiar with different reimbursement methodologies including but not limited to Medicare current SNF reimbursement, Per Diem, Capitation, and Value Based incentive.
• Knowledge of CPT-4, HCPCS, Revenue, and ICD coding
• Expert in Managed Care plans
• Experience in successful operationalizing managed care contracts.
• Knowledge of contracts and contractual interpretations for payment and benefit issues and understanding or 1500 and UB claims forms requirements for Outpatient Therapy services all settings.
• Working knowledge of medical terminology, claims payment, contract negotiations, and proactive problem resolution; ability to work collaboratively in a team setting. Communicate effectively (written and verbal) at all organizational level and with external partners.
• Must be able to read, write, speak, and understand the English language.
• Must possess the ability to make independent decisions when circumstances warrant such action.
• Must possess the ability to deal tactfully with personnel, residents, family members, visitors, government agencies/personnel, external partners, and the general public.
• Must have patience, tact, a cheerful disposition, and enthusiasm. As well as a willingness to handle difficult situations and bring solution to the table in collaboration with Operations and the Service Center.
• Will travel 50% of the time throughout the markets with additional travel to other Markets or the Service Center

Additional Information:
This position can be located in: Texas, Arizona, California
Salary: $90,000-$120,000 DOE; may be eligible for bonus
The employer for this position is stated in the job posting. Ensign Services, Inc. provides recruiting services for operations in the skilled nursing, assisted living, home health and hospice industries.
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