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JOB DESCRIPTION:

Director, Payor Relations & Regulatory Affairs

The Opportunity

Acelis Connected Health’s (ACH) DME & IDTF businesses operate across all states in the US with several hundred payor plans to serve it’s 80,000 patients on service. This Director, Payor Relations and Regulatory Affairs will be accountable to develop strategies and drive ongoing activities that maintain and expand payor coverage while ensuring ACH remains compliant standards required by The Joint Commission, state agencies, and CMS (Medicare/Medicaid). These activities include leading the development, implementation, and monitoring of processes related to commercial payor contracting, state licensing, and CMS enrollments. These processes span across all lines of business at ACH.

What You’ll Work On

The following reflects essential functions for this job, but does not restrict the tasks that may be assigned. Management may assign or reassign duties and responsibilities to this job at any time due to reasonable accommodation or other reasons.

• Directly hires, develops, and drives engagement for team members across Payor Relations and Regulatory departments

• Oversees essential activities and process improvement related to commercial payor contracting across all lines of business; specific contracting activities include, but are not limited to:

• Contract redlining

• Contract implementation

• Contract monitoring

• Contract management, including initial & ongoing credentialing

• Payor escalation management, including payment discrepancy resolution

• Oversees essential activities and process improvement related to regulatory affairs for ACH; specific contracting activities include, but are not limited to:

• State licensing

• Medicare and Medicaid enrollments

• The Joint Commission Accreditation

• Maintains governance processes to ensure alignment to contracting and regulatory business expectations with cross-functional stakeholders, including: finance, commercial operations, revenue cycle management, legal, and the office of ethics & compliance

• Develops, maintains, and presents to leadership the KPIs/metrics related to areas of responsibility

• Contributes to business strategies related to commercial contracting, payor management, and regulatory compliance; examples include: patient access, pricing, payor management, Medicaid advocacy, state licensing applications, and accreditations.

Required Qualifications

• Bachelor’s Degree in a business discipline
• 10 years relevant experience in payor contracting at a healthcare provider, payor, or network
• 5 years directly interacting with regulatory agencies
• Demonstrated ability to develop, improve, and monitor commercial contracting processes
• Ability to work independently and managing competing priorities routinely.

Preferred Qualifications

• Master’s Degree in related field
• 5 years experience in payor contracting within the DME/IDTF provider space
• 5 years experience working directly with CMS (Medicare/Medicaid), The Joint Commission, and state licensing agencies

[APPLY NOW

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Participants who complete a short wellness assessment qualify for FREE coverage in our HIP PPO medical plan. Free coverage applies in the next calendar year.

Learn more about our health and wellness benefits, which provide the security to help you and your family live full lives:  www.abbottbenefits.com

Follow your career aspirations to Abbott for diverse opportunities with a company that can help you build your future and live your best life. Abbott is an Equal Opportunity Employer, committed to employee diversity.

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The base pay for this position is

$172,000.00 – $344,000.00In specific locations, the pay range may vary from the range posted.

JOB FAMILY:

Regulatory Operations

DIVISION:

HF Heart Failure:

LOCATION:

United States > Livermore : 6465 National Drive

ADDITIONAL LOCATIONS:

WORK SHIFT:

Standard

TRAVEL:

Not specified

MEDICAL SURVEILLANCE:

Not Applicable

SIGNIFICANT WORK ACTIVITIES:

Keyboard use (greater or equal to 50% of the workday)

Abbott is an Equal Opportunity Employer of Minorities/Women/Individuals with Disabilities/Protected Veterans.

• EEO is the Law link

• English: http://webstorage.abbott.com/common/External/EEO_English.pdf

• EEO is the Law link

• Espanol: http://webstorage.abbott.com/common/External/EEO_Spanish.pdf