Senior Manager, Payor Relations & Regulatory Affairs

Job Description

Job Description

The Opportunity:

This position provides regulatory compliance leadership for the business, ensuring the policies, procedures, and practices of the business remain compliant to regulatory and contract requirements.

Responsibilities:

• Directly manages the team responsible for following: CMS enrollment, Medicaid enrollment, state licenses, Joint Commission accreditation, payor contract review, and quality systems
• Develop and participate in setting compliance strategies and initiatives.
• Oversee business policies, processes and programs to ensure business remains compliant to regulatory and contract requirements
• In charge of audits and regulatory inspections.
• Responsible for ensuring business licenses are up to date and compliant with all geographies the business operates within
• Provides oversight into the complaint management process and reporting requirements
• Leads organization through all activities required to maintain Joint Commission accreditation
• Monitors relevant regulations for changes applicable to business and ensure policies and procedures are updated as needed
• Ensure timely processing of sales contracts and Medicaid enrollments
• Negotiate and draft high-value complex contract terms and conditions in accordance with corporate policies
• Acts as a Contract Administration lead and be able to train new hires
• Analyze potential risks that contract changes may pose to the organization and provide a solution
• Present and explain contract conditions and details to customers, business partners, and management
• Work with different levels of personnel within an organization to analyze and solidify an overall contract strategy
• Interface with internal fulfillment groups and distributors to establish working relationships, assure proper end-user pricing and contract effective dates are loaded
• Perform other duties & projects assigned.
• Understands and is aware of the quality consequences which may result from the improper performance of their specific job.

Required Qualifications:

• Demonstrated ability of effective and constructive communication across departmental disciplines while pursuing contract department goals.
• Experience and competency with EMR systems, Government and Insurance Portals
• Must have excellent oral, written and interpersonal communication skills
• Must have customer service attitude & good computer skills (Microsoft Word, Excel, Outlook, etc.)
• Self-starter and a multi-tasker
• Ability to work in a high volume, dynamic team environment

Preferred Qualifications:

• 10+ years of relevant experience
• Bachelor's degree or equivalent experience
• Experience with regulations pertaining to being a service provider for durable medical equipment (DME) and/or an independent diagnostic test facility (IDTF) strongly preferred