Managed Care Director (Chicago, IL area)
- Articulate LabCorp's value proposition and communicates LabCorp's test offerings to health plan contracting and medical teams.
- Secure coverage and reimbursement for new technology and focus tests.
- Work with health plans to improve coverage positions for tests.
- Reviews and responds to proposals and contracts. Negotiates pricing, execution and implementation of the contracts for selected Managed Care accounts. Review Managed Care contracts from a financial and operational basis and work with division/regional business development, financial and contract administrators in order to represent all LabCorp's interests in contract negotiations
- Modifies existing contracts to appropriately reflect LabCorp's operational policies, procedures and capabilities.
- Responsible for models for pricing review. Initiate programs and processes to retain current business and grow the business in each contract, including maximizing pull through opportunities.
- Communicates to the division and LCA management on the performance of the division/region's Managed Care customers, including problems, concerns, and issues related to billing/customer service and reimbursement. Works with appropriate departments and managers to resolve issues.
- Analyzes and monitors fees for Managed Care customers. Includes utilization review and analysis for capitation rate adjustments for capitated plans. Ensures that regular price adjustments are implemented (with approval). Negotiate and implement pricing for years of coding, exclusions and new technology.
- Develops and implements Business Plan for Managed Care with a focus on profitable contracts with strategic significance for Division/Region an annual basis. Provides monthly update reports to management. Maintain regional Managed Care plan relationships focusing on regional "Anchor Plan" strategy.
- Responsible for relationships and communication with Managed Care plans. Periodic meetings with each plan are required. Quality reporting, Lab Leakage Initiatives, operational initiatives, demographic updates, new technology, etc. should be reviewed at joint operational meetings with customers.
- Verifies accounts are tracked in system appropriately and provides explanation of variations in accession volume and revenue.
- Keep informed of developments and trends relating to all areas of the company and MCO/PPO plans.
- Interact with all appropriate departments and sales personnel to ensure the proper handling and service of national accounts. Upsell accounts and address leakage through reports generated at LabCorp or from the plans. Attend sales meetings to provide training and templates as needed. Partner with sales team for client visits as needed.
- Works with billing supervisor to communicate contract specifics for new plans and changes in data requirements for existing plans to the field.
- Assists Contracts Administrator in conjunction with legal department on all contracts.
- Participates in Company assigned projects and attends required meetings.
- Maintains company required records and make reports on all phases of activities
- (May be performed by MCAM, if available) Research, troubleshoot and resolve service issues related to national MCO/PPO accounts. (includes eligibility issues, report transmissions, specimen flow and TAT, demographic requirements, A/R issues, service issues, etc.) Monitor service and performance of accounts including billing, pricing, systems requests, payment activity, QA/QI reports, etc.
- (May be performed by MCAM, if available) Work with Reimbursements Department and Billing Analysts to verify that fee schedules are reimbursed appropriately, rate changes are implemented and A/R issues are identified. When reimbursement or claims transmission and processing issues are identified, negotiate and track issues until successfully resolved.
** This job description reflects only the essential functions of the position and excludes those which may be incidental to the performance of the job. In no way it is stated or implied that the principal functions are the only duties to be performed. Employees will be required to follow any other job-related instructions and to perform any other job related duties requested by supervisor.
- Bachelor's degree or equivalent combination of education and experience.
- Professional, articulate and financially astute salesperson.
- Strong presentation skills and excellent negotiation, sales, analytical, communication and PC skills.
- Must be able to serve as internal subject matter expert for managed care team.
- Knowledge of principles of Managed Care, including plan types (HMOs, PPOs, etc.) and understanding of progressive health care dynamics, including Risk-Sharing, value based reimbursement, medical policy and laboratory utilization management programs.
- Must have understanding of capitated and fee-for service reimbursement arrangements, and knowledge of CPT and ICD-10 coding.
- 10+ years Managed Care Experience required, Sales and Lab background preferred.