Director, Payor Relations & Regulatory Affairs

Abbott is a global healthcare leader that helps people live more fully at all stages of life. Our portfolio of life-changing technologies spans the spectrum of healthcare, with leading businesses and products in diagnostics, medical devices, nutritionals and branded generic medicines. Our 115,000 colleagues serve people in more than 160 countries.

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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The base pay for this position is $172,000.00 – $344,000.00. In specific locations, the pay range may vary from the range posted.

• business strategy development
• payor contracting
• contract management
• contract monitoring
• kpi development
• payment discrepancy resolution
• medicare and medicaid enrollments
• governance processes
• payor escalation management
• cms enrollments
• contract redlining
• contract implementation
• regulatory compliance
• stakeholder management
• presentation skills
• commercial contracting
• the joint commission accreditation
• state licensing