Position Summary
This is for a position with the Nufactor Managed Markets Team. The Director Contracting Operations is responsible for the maintenance, organization and centralization of all contracting efforts (credentialing & recredentialing) related to all Payor types including but not limited to: Managed Care Organizations (MCOs), Preferred Provider Organizations (PPOs), Individual Practice Associations (IPAs), Pharmacy Benefit Managers (PBMs), and all applicable state Medicaid Programs. All contract coordinator staff will report directly to Director of Contracting Operations.
Essential Functions and Duties
- Continuously strive to improve contracting process quality with internal and external customers and enhance interdepartmental employee relations with regards to contracting efforts.
- Centralize and maintain all Contracting material (Agreements, Amendments, database etc.) related to all MCO, PPO, IPA, PBM and Medicaid contracts.
- Maintain organization of all Contracts so they are current and accessible in all appropriate systems (currently SharePoint and ConvergePoint).
- Act as dedicated initial point of contact for Nufactor with regards to initiation of review on all existing/current and new contracts.
- Work closely with multiple departments (Legal, Reimbursement, Managed Markets, Accounting, etc.) to facilitate a timely review and approval of new contracts and corresponding reimbursements, procure appropriate signatures, follow-up on countersignatures and effective date of agreement, and distribute needed information to sales and billing/reimbursement.
- Maintain and track all Letters of Agreement (LOAs); notify Operations of any LOA due for renewal; coordinate negotiated rates and updated terms for renewed or new LOAs; obtain required signatures; and notify Operations once the LOA is countersigned.
- Support Managed Care leadership by assisting with contract requests, credentialing applications, and Ownership/Control Forms as initial steps in the contracting process.
- Facilitate development of “Contract Review Guide” for each new Contract to highlight key pricing and billing requirements for each new Agreement.
- Add Nufactor pharmacy locations, and supply licensing and all requested documentation to HMO and PPO agreements as applicable.
- Maintain and update all Medicaid provider state licensing and regulations, as well as working to become a provider with un-contracted states.
- Coordinate contracting for all PPO, PBM and other Part D plans contracting for all pharmacy locations.
- Create, update and maintain contract and pricing information within the Homecare Net software program on all new and existing agreements and as requested by the NuFactor billing/reimbursement department.
- Maintain and distribute an updated pricing schedule that includes current acquisition, Average Sale Price (ASP), Average Wholesale Price (AWP), Wholesale Acquisition Cost (WAC) and Usual and Customary pricing on a quarterly basis.
- Prepare and distribute sales reports detailing revenue by plan, geographic region and product as requested.
- Prepare and distribute annual FWA and offshore attestation forms, in coordination with the Compliance Officer, to all relevant payors.
- Provide timely, accurate, and complete reports and information when requested and other duties as assigned.
- Adheres specifically to all company policies and procedures, Federal and State regulations and laws.
- Display dedication to position responsibilities and achieve assigned goals and objectives.
- Represent the Company in a professional manner and appearance at all times.
- Understand and internalize the Company’s purpose; Display loyalty to the Company and its organizational values.
- Display enthusiasm and dedication to learning how to be more effective on the job and share knowledge with others.
- Work effectively with co-workers, internal and external customers and others by sharing ideas in a constructive and positive manner; listen to and objectively consider ideas and suggestions from others; keep commitments; keep others informed of work progress, timetables, and issues; address problems and issues constructively to find mutually acceptable and practical business solutions; address others by name, title, or other respectful identifier, and; respect the diversity of our work force in actions, words, and deeds.
- Comply with the policies and procedures stated in the Injury and Illness Prevention Program by always working in a safe manner and immediately reporting any injury, safety hazard, or program violation.
- Ensure conduct is consistent with all Compliance Program Policies and procedures when engaging in any activity on behalf of the company. Immediately report any concerns or violations.
Education, Knowledge, Skills and Experience
Required Education:
A Bachelor’s Degree in Business Administration or similar field.
Required Knowledge and Skills:
- Possess excellent organizational, time management, analytical and communication skills (verbal and written).
- Show detail oriented, logical, and methodological approach to problem solving and ability to function with a high degree of independence.
- Must be extremely customer-focused and portray a “can do” approach to problem solving.
- Ability to juggle multiple tasks and projects simultaneously and rearrange priorities, as needed.
Required Experience:
Minimum five (5) years experience in relative health care industry including management, sales, clinic services, or customer service. Prefer three (3) to five (5) years experience in hemophilia or similar chronic disorder.
Physical requirements
Vision, hearing, speech, movements requiring the use of wrists, hands and/or fingers. Must have the ability to view a computer screen for long periods and the ability to sit for extended periods. Must have the ability to work the hours and days required to complete the essential functions of the position, as scheduled. Must have the ability to lift and maneuver items of at least 20 lbs. Must have the ability to travel occasionally. Working condition include normal office setting.
Mental Demands
Learning, thinking, concentration and the ability to work under pressure, particularly during busy times. Must be able to pay close attention to detail and be able to work as a member of a team to ensure excellent customer service. Must have the ability to interact effectively with co-workers and customers, and exercise self-control and diplomacy in customer and employee relations’ situations. Must have the ability to exercise discretion as well as appropriate judgments when necessary. Must be proactive in finding solutions
Direct Reports
Yes
EEO Statement
FFF Enterprises and Nufactor are an equal opportunity employer and prohibits discrimination and harassment based on the following characteristics: race, color, religion, national origin, physical or mental disability, gender, age (40 years and over) qualified veteran and any other characteristic protected by state or federal anti-discrimination law covering employment. These categories are defined according to Government Code section 12920. The Company prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has or is perceived as having any of those characteristics.
Acknowledgement
The above statements are intended to describe the general nature and level of work being performed by the incumbent assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and/or skills required of all personnel so classified.
The undersigned employee acknowledges receipt of the Job Description for the employee’s position and understands the essential functions, responsibilities and qualifications of the position. Furthermore, the employee acknowledges that this Job Description does not include all of the essential functions of this position, and that these essential functions may change as deemed necessary by the manager.
Other items to consider:
- Regularly locate and update provider manuals for all payor types and archive outdated manuals.
