DIRECTOR OF CONTRACTING Pentec Health

Objective:
Under the direct supervision of the CFO, this position is accountable for the day-to-day operations of the
Payer Contracting department. This role is accountable for identifying, negotiating, securing and
implementing new payer contracts, identifying additional reimbursement opportunities in Pentec Healths
existing payer contracts to meet companys financial goals. Work closely with the organizations Revenue
Cycle Management and Sales departments to ensure seamless communication, implementation
and resolution to all payer specific projects.
Essential Duties & Responsibilities:
The following tasks are considered to be typical and significant, any one or all of which may be performed by this position:
1. Work with the Renal and Specialty Home Infusion teams to identify and secure participating provider contracts in both
expansion and current markets.
2. Provide direction and manage field based Contracting representatives with the daily operations of the Contracting
department.
3. Work with the Intake and Billing Teams to ensure a thorough understanding of contract terms and requirements for
authorization and reimbursement.
4. Meet directly with key payer personnel to establish a relationship between them and Pentec Health and to differentiate us
versus competition.
5. Work closely with Field Sales Teams to secure participating provider contracts for key plans from targeted referral
sources.
6. Thoroughly understand the clinical services and specific market segment messages as it relates to Specialty Infusion and
Renal services.
7. Thoroughly understand the vision, positioning and strategy of Specialty Infusion and Renal services and actively engage
in support and improvement of them.
8. Fully utilize organizations contracting and billing system (CPR+) functionality to accurately input contract terms and
reimbursement for optimum billing and collections.
9. Proactively identify areas of automation that improve service levels to payers and internal staff.
10. Proactively identify areas of improvement; and develop and implement plans that address them.
11. Identify possible reimbursement carve out contract terms with identified payers to ensure Pentecs reimbursement meets
and exceeds companys financial goals.
12. Assist Intake departments with complex prior authorizations and single case agreements from non-contracted payers.
13. Maintain electronic and hard copy Contract files and database to ensure easy access of specific payer terms.
14. Manage training overview from newly contracted payers to ensure all applicable authorization and billing requirements
are understood and implemented by Pentecs Intake and Reimbursement departments.
15. Strategize, create and implement contract opportunities with payers that do not have established payment for Pentecs
services.
16. Perform other special projects and assignments as directed by the CFO.
Authority & Accountability
1. Manage staff of 2 field based Payor Contract Representatives
Skills, Competencies
To perform the job successfully, an individual should demonstrate the following competencies to perform the essential
functions of this position:
1. Knowledge of specialty infusion and pharmacy markets.
2. Knowledge of insurance market, payer contracting and the ability to travel.
3. Knowledge of all billing codes utilized by both the Specialty Home Infusion and Renal operations.
4. Demonstrated CPR+ (or similar system) and Microsoft Office computer skills.
5. Detail oriented, highly organized, and personable.
6. Have strong communication and customer service skills.
7. Problem solver and exceptional team player.
Experience:
1. Familiarity of medical field and US healthcare system.
2. 7 -10 years prior work experience in a contracting position within health plans, insurers, specialty infusion providers or
home health care agencies required.

Location:	Four Creek Parkway Suite A Boothwyn, PA 19061 United States