TITLE: Director of Contracting and Medi-Cal Plan Relations
DIVISION: Center for Economic Services
REPORTS TO: Vice President
OFFICE LOCATION: Sacramento
EXEMPTION STATUS: Exempt
POSITION SUMMARY: The Director of Contracting and Medi-Cal Plan Relations will be a key member of CMA's Center for Economic Services, advocating for CMA physician members on contracting, reimbursement, and other practice operational issues, with a focus on Medi-Cal and managed care issues.
The Director will advocate for members by establishing effective relationships with payors that promote a problem-solving focus on member specific reimbursement, contracting, and policy level issues and creating and maintaining effective liaison relationships with appropriate regulatory bodies and other stakeholders. Advocacy may be in written form or through verbal communication to payors or regulators to achieve responsive action when needed. The Director will work with county medical societies and specialty medical societies, as appropriate, to assure local and specialty physician involvement in CMA advocacy efforts and will also support other CMA advocacy teams.
The Director will provide direct assistance to CMA members and their staff, will provide coaching and education on contracting, reimbursement, and practice management topics. There will be a heavy focus on the development of resources and tools to empower physician practices, such as toolkits, articles, and seminar/webinar programs, focusing on payor contracting and Medi-Cal related practice management issues.
Essential competencies include critical thinking, including problem solving and intellectual curiosity, effective communication, approachability, customer service, relationship building and collaboration, and flexibility.
- Provide one-on-one assistance to physician members and their staff on practice management issues in a timely manner.
- Stay up to date on payor contracting, reimbursement and other practice management related manners. Achieves and maintains knowledge base on assigned topics.
- Develop relationships with payor contacts to facilitate a collaborative exchange of information and promote responsiveness to CMA inquiries. Such relationships must be handled with the utmost professional demeanor and focus on solutions to the underlying issues.
- Establish relationship with key regulatory agency contacts. Demonstrate knowledge and respect for role of regulatory body and establish self as trusted resource of knowledge and expertise – a “go to “resource.
- Utilize knowledge of general coding principles and detailed understanding of applicable regulations, laws, product types, payor policies, utilization management requirements and appeal processes with sufficient expertise to support CMA members and CMA advocacy staff.
- Develop educational materials, resources, articles, and programs for physician members and their staff.
Stay apprised of upcoming developments in order to anticipate impending changes and need for CMA intervention.
- Consult and coordinate with component medical societies on physician practice management issues and concerns related to payor performance.
- Support other CMA advocacy staff by providing feedback on proposed resolutions or legislative proposals.
CONTACTS: Significant contact with CMA members and their office staff, county medical societies, regulatory agencies, payor representatives, CMA management and supervisorial staff and officials of other organizations.
- Strong communication, writing, and collaboration skills.
- Independent, self-starter willing to take the initiative while working effectively in a team.
- Deep knowledge of managed care payor contracting, including key provisions, preparation for negotiations and contract monitoring and compliance.
- Strong customer service and time management skills to ensure member issues are addressed effectively and timely.
- Working knowledge of medical practice operations, including billing and collections, payor contracting, appeals, or related activities derived from experience in medical practice or health plan operations.
- Ability to effectively listen and engage in problem solving, research issues, and respond to physician members in a timely fashion.
- Ability to handle multiple complex issues in a fast-paced environment.
- Strong interpersonal skills that encourage openness, trust and productive relationship building and teamwork.
- Ability to create and conduct workshops and webinars on practice management related topics.
PHYSICAL REQUIREMENTS: Position requires some travel, primarily within California.
(This job description reflects the general level and nature of the job. It is not intended to be all inclusive.)