Director, Contract & Provider Services

Emory•Atlanta, GA

7d•Hybrid

About The Position

The Director/Corporate Director of Managed Care Contracting & Provider Services supports the Vice President of Contracting & Provider Services in developing and executing enterprise managed care strategies across Emory Healthcare. As a senior strategic and operational leader, this role advances organizational priorities through cross-functional collaboration, complex problem solving, and implementation of enterprise initiatives across a highly matrixed healthcare environment. The position is responsible for managed care contracting, payer relations, reimbursement strategy, payer dispute resolution, and operational initiatives that support system performance, growth, market competitiveness, patient access, contract performance, and margin improvement across Emory Healthcare entities. The Director leads complex managed care agreements and payer initiatives; develops reimbursement strategies; represents the organization in payer relationships and disputes; supports strategic growth and business development; and provides leadership, mentorship, and professional development support to the Managed Care department. This is a hybrid position, splitting time between remote work and onsite work. Travel of less than 10% is required.

Requirements

Bachelor's degree in Business Administration, Healthcare Administration, Finance, Public Health, or a related field.
At least 7 years of progressive professional experience within an academic medical center, integrated health system, multi-hospital health system, managed care organization, or related healthcare environment.
At least 5 years of experience directly focused on managed care contracting.
Demonstrated experience in healthcare analytics, managed care contracting, payer relations, reimbursement strategy, and financial analysis.
Direct experience leading negotiation, implementation, and management of complex managed care agreements.
Strong negotiation and relationship-building capabilities.
Demonstrated strategic thinking, business and financial expertise, and ability to identify and solve complex organizational challenges.
Proven ability to lead initiatives through collaboration and influence across diverse stakeholders and operational areas.
Expert knowledge of managed care contracting, reimbursement methodologies, payer-provider relationships, and healthcare finance.
Strong understanding of commercial, Medicare Advantage, Medicaid, value-based reimbursement models, and alternative payment arrangements.
Exceptional communication, presentation, negotiation, and relationship-management skills.
Strong analytical, organizational, and problem-solving abilities.
Ability to lead through influence in a highly matrixed healthcare environment.

Nice To Haves

Master's degree.
10 or more years of experience.

Responsibilities

Support the Vice President of Contracting & Provider Services in developing and executing departmental strategies, operational priorities, and organizational initiatives.
Serve as a senior departmental leader and trusted delegate to the Vice President, representing departmental priorities and supporting decision-making in the Vice President's absence or as delegated.
Work with organizational leadership to develop managed care strategies and lead departmental initiatives advancing growth, market competitiveness, patient access, contract performance, and margin improvement.
Represent the department in executive meetings, payer negotiations, governance committees, and other strategic initiatives as delegated.
Lead the negotiation and management of complex managed care agreements, including commercial, Medicare Advantage, Medicaid, value-based, employer-sponsored, and alternative reimbursement arrangements.
Lead the negotiation, implementation, administration, and optimization of managed care agreements across Emory Healthcare entities, including hospitals, employed physician practices, the clinically integrated network, ambulatory surgery centers, joint ventures, and affiliated provider networks.
Guide execution of complex payer initiatives and promote consistency in strategic decision-making and contracting practices across the organization.
Develop and execute payer and reimbursement strategies that support Emory Healthcare's financial and strategic objectives.
Identify opportunities to improve reimbursement, contract performance, revenue outcomes, and payer relationships.
Lead financial dispute strategy and operational initiatives that support system performance and financial objectives.
Serve as a senior liaison and representative between Emory Healthcare entities, payer organizations, and external stakeholders.
Lead efforts to resolve complex contractual, operational, reimbursement, and financial disputes with payers.
Support acquisition, affiliation, network expansion, Centers of Excellence, direct-to-employer contracts, and other strategic growth initiatives.
Partner with Finance, Revenue Cycle, Legal, Compliance, Population Health, Strategy, Business Development, Operations, and Physician Leadership to advance organizational objectives.
Collaborate with operational, financial, clinical, and executive leaders to advance enterprise objectives and maximize contract performance.
Provide strategic leadership across the Managed Care department as a mentor, advisor, and resource to the team.
Foster collaboration, knowledge sharing, innovation, and professional development in support of departmental and organizational objectives.
Perform additional duties as assigned.