Assistant Director, Contracting & Balance Billing

1199SEIU Benefit and Pension Funds; New York (NY); Hybrid; USD 120,000 - 160,000; Full time

Benefits offered by this job

Hybrid work model

Job summary

1199SEIU National Benefit Fund is seeking a senior manager to lead the Balance Billing & Fee Negotiation and Contracting team within Provider Relations. You will plan, strategize and oversee operations, manage NSA/IDR negotiations, and ensure contracting with facilities, vendors and providers aligns with regulatory guidelines.

The role requires extensive experience in managed care, strong negotiation skills, and the ability to drive compliance and efficiency across the organization.

Qualifications

• Bachelor's degree in business or health-related field required.
• Master’s Degree preferred.
• Minimum six (6) years relevant experience in managed care, contracting, and network management including four (4) year supervisory experience.
• Knowledge of fee negotiations, reimbursement methodology, and contract language review process.
• Broad knowledge of ERISA, DOL, HIPAA, PHI, ACA compliance.
• Excellent written, organizational and communication skills; detail-oriented.
• Knowledge of hospital and medical claims adjudication, billing terminology, and Medicare policies.
• Proven multi-tasking skills and ability to meet deadlines.
• Intermediate Microsoft Suite (Word/Excel) proficiency.

Responsibilities

• Plan, strategize and oversee daily operations of the Balance Billing & Fee Negotiation, and Contracting units under Provider Relations department.
• Oversee and manage NSA/IDR negotiations and rates for out-of-network hospital and medical services.
• Oversee contracting activities with facility types, vendors, and ancillary providers; enforce contract compliance.
• Maintain contract documents; ensure changes to templates are approved by Legal.
• Facilitate negotiation of contract rates and terms; capture, monitor and report metrics.
• Collaborate with outside fiduciary to implement rates for inpatient/outpatient hospital services; respond to provider issues.
• Manage staff according to department procedures and Collective Bargaining Agreement.
• Maintain integrity, ethical conduct and candor in communications.
• Collaborate with other departments to refine workflows and serve members.
• Perform additional duties and projects as assigned.

Skills

Contracting experience

Supervisory experience

Fee negotiations

Reimbursement methodologies

Communication skills

Multi-tasking

Deadline-driven

Microsoft Suite

Education

Bachelor's degree in business or health-related field

Master's degree

Tools

Microsoft Word

Microsoft Excel

Microsoft 365

Job description

Requisition #:

7508

# of openings:

1

Employment Type

Full time

Position Status

Permanent

Category

Non-Bargaining

Workplace Arrangement

Hybrid

Fund

1199SEIU National Benefit Fund

Job Classification

Exempt

Responsibilities

• Plan, strategize and oversee daily operations of the Balance Billing & Fee Negotiation, and Contracting units under Provider Relations department


• Oversee and manage the Balance Billing & Fee Negotiation unit, an area responsible for handling NSA (No Surprises Act) and IDR (Independent Dispute Resolution negotiations, and other negotiations associated with members balance billed by providers including facilities for voluntary and involuntary access to participating and non-participating providers by eliminating and reducing out-of-pocket cost incurred by the members; oversee and negotiate rates for out of network hospital and medical services


• Oversee and manage contracting activities with all facility type, including freestanding ASCs, vendors, and ancillary providers and enforce contract compliance


• Responsible for the maintenance of the contract documents, including professional agreements, letters of agreement, amendments, ancillary, facility and hospital services agreements; ensure that any changes to the contract templates are approved by the Legal Department


• Facilitate the negotiation of contract rate and terms upon requests within applicable financial and operational goals; capture, monitor and report on key metrics


• Collaborate with the Funds’ outside fiduciary to implement rates for inpatient and outpatient hospitals services; respond to provider issues and concerns to ensure high volume hospitals, vendors, and networks are managed effectively


• Manage staff in accordance with established department procedures, Human Resources guidelines and provisions of the Collective Bargaining Agreement


• Honor commitments consistent with organization and department’s vision, behave ethically and act with integrity, and communicate with candor


• Be passionate about the members we service, set high expectations and be accountable, collaborate with other departments and other Provider Relations areas to develop or refine shared workflows


• Perform additional duties and projects as assigned by management

Qualifications

• Bachelor’s degree in business or health related field required; Master’s Degree preferred.


• Minimum six (6) years relevant experience in managed care, contracting, and network management including four (4) year supervisory experience required


• Knowledge of fee negotiations, reimbursement methodology, and contract language review process


• Broad knowledge and understanding of applicable laws, regulations, requirements, and protocols in compliance and adherence (ERISA, DOL, HIPAA, PHI, ACA)


• Excellent written, organizational and communication skills; detail-oriented with interpersonal and team building skills


• Knowledge of hospital and medical claims adjudication process, medical billing and coding terminology, and Medicare and industry billing policies and procedures


• Proven multi-tasking skills and ability to meet critical deadlines


• Intermediate level of Microsoft Suite/365, Word and Excel