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(1130) Director of Payor Relations

Job Description

Under the supervision of the Director of Business Operations, this position ma work remotely and is responsible for the management and oversight of payor contracting, negotiations, and authorization of all programs Single Case Agreements with payors. Position will analyze contracts and assist in annual managed care strategic planning supporting the rationale and execution. He/she will perform monitoring of key performance measures and act appropriately to ensure the financial success of the organization. The position will be responsible for oversight of the network plan contracts, gaining entry for eligible Bluebonnet professionals onto network provider panels, responsible for vendor selection and training of staff management of the selection on the insurance eligibility process, and stay abreast of payor prior authorization changes and process to ensure organization is not at risk. Responsible for the management and oversight of provider and facility credentialing/re-credentialing with commercial insurance and managed care companies to include provider revalidations with CMS and Medicaid entities. Director of Health Plan Reimbursement will serve as the primary contact and project lead on development of value-based contract arrangements.

Position will be responsible for the management and supervision of the center’s consumer benefits program and staff. The individual will collaborate with a cross functional team to optimize programs and processes in a rapidly changing payer environment. He/she will develop and support business solutions for continued success of benefits services, per-authorization of services and patient insurance eligibility in a rapidly changing service delivery environment. Performs other duties as assigned. The position will be responsible for escalation of global and systemic claims denials projects and claims settlement actions. Director of Health Plan Reimbursement will maintain ongoing collaboration with the billing department to mitigate any potential loss of revenue.

Location: Regional; Remote within the BTCS Service Area

Salary: TBD

Why join our team?

BTCS Values our team members and believes it is important to reward and compensate our team members for their contribution to our success. BTCS offers competitive salaries, an excellent benefits package and generous leave accruals.

Medical Insurance: Through BlueCross Blue Shield, we offer comprehensive medical coverage for you and your eligible dependents with access to network and non-network health care providers. Coverage for employees and eligible dependents begins on the first day of the month following 60 days of employment.

Dental Insurance: Through Dental Select, we offer two coverage plans for dental care, to include preventative, basic and major services. Coverage for employees and eligible dependents begins on the first day of the month following 60 days of employment.

Vision Insurance: Through BlueCross BlueShield, we offer vision coverage to include discounts on everyday vision needs, such as eye exams and glasses and/ or contacts. Coverage for employees and eligible dependents begins on the first day of the month following 60 days of employment.

Prescription Plan: Through BlueCross BlueShield, we offer discounts on generic, preferred or brand-name drugs as well as non-preferred drugs at pharmacies or through a convenient home delivery program. Coverage for employees and eligible dependents begins on the first day of the month following 60 days of employment.

Flexible Spending Accounts: Optional pre-tax contributions for medical reimbursement and dependent care plans.

Retirement Plans:
401A: Through this governmental plan, we offer a 7% match to employee contributions.
457/403(b): Through these governmental plans, employees may contribute pre-tax earnings for retirement. Employees may participate on the first day of employment.

Sponsored Insurance:
Life Insurance: Through Dearborn National, we offer basic life insurance of $5,000. Optional supplemental coverage, as well as spouse and eligible dependent policies, are available to purchase.
Long Term Disability/ Accident/ Critical Illness Insurance: Through Dearborn National we offer optional insurance coverages at a competitive rate. Coverage for employees and eligible dependents begins on the first day of the month following 60 days of employment.

Family and Medical Leave: Job protection to provide care related to a child’s birth or adoption, or for yourself or a family member’s serious health condition.

Employee Assistance Program: Through Alliance Worksite Solutions, we offer a no cost, confidential employee assistance program as a resource to resolve personal, family, financial and legal problems for employees and their dependents.

Professional Development: Joining Bluebonnet Trails is about joining a culture of inclusiveness, collaboration, trust, and the invitation and expectation to have a voice. Bluebonnet offers employees the opportunity to participate in professional development that is skill based and offers continuing education courses to enhance knowledge and performance via online courses and instructor led webinars.

Additional Perks:
– Employee Referral Awards
– Licensure Supervision
– Licensure Renewal Fee Reimbursement
– Public Service Loan Forgiveness Programs
– Educational Leave
– Competitive Pay Differentials for Applicable Positions

CityRemote within the BTCS service area
CountyBastrop County, Burnet County, Caldwell County, Fayette County, Gonzales County, Guadalupe County, Lee County, Williamson County
CredentialsMinimum Qualifications: Bachelor’s degree in any field with at least four years of employment in a management position with demonstrated success in leading a large team. Knowledge of service reimbursement codes. Demonstrated experience working with managed care operations, network plans and network plan contracts, insurance eligibility requirements, and Medicaid/Medicare eligibility processes.

Qualified candidates must have a strong customer-focused alignment and relationship base and demonstrate a record of success in their ability to lead and inspire a reimbursement team towards meeting and exceeding objectives, to communicate and implement tactical strategies, to think strategically (i.e., "outside the box" and look at the "big picture") while providing creative and innovative solutions to identified problems. Personal integrity and leadership abilities are essential. Excellent interpersonal, communication (both written and verbal), and excellent presentation skills are required. Must be able to effectively multi-task, problem-solve, and make decisions.

Preferred Qualifications: Master’s degree in Business Administration and/or marketing experience preferred. Demonstrated success in leading a team in a highly competitive and managed care market. Direct experience working within a community mental health and/or healthcare setting. 5 years of experience in rate analysis, contracts negotiation, and Managed Care.
Salary Amount$TBD/year
Closing DateOpen until filled
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1009 North Georgetown Street
Round Rock, Texas 78664

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Bluebonnet Trails Community Services as a recipient of Federal Transit Administration (FTA) grant dollars either directly from FTA or through the Texas Department of Transportation (TxDOT), will comply with the Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d), the U.S. Department of Transportation implementing regulations, FTA Circular 4702.lB, and TxDOT PTN requirements as specified in Master Grant Agreement, and State Management Plan. Our Title VI Plan can be viewed here: Title VI Plan 2023-2026

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