Director - Managed Care Payor Contracting

HonorHealth•Scottsdale, AZ

3d•Remote

About The Position

The Director Payor Contracting develops payor contracting strategies with senior management for the organization’s Network, including strategies for health plans, government entities, employers, Network facilities, employed physicians, bundled payments, joint ventures, ambulatory care, Federally Qualified Health Centers, and clinically integrated networks. The role manages and directs Network contracting, including pricing, negotiation, and profitability, and works with Enterprise Analytics, Physician Billing, and Finance to develop and analyze contracting information and assess payer and employed physician profitability. The Director works with clinical and administrative teams to operationalize Network contracts, minimize lost revenue, decrease costs, accelerate cash flow, and improve reimbursement. The role builds internal and external relationships with payers, physician leadership, management, employees, and contracting or joint-venture partners. It leads the Network Reimbursement Team, serves as a consultant to the employed medical group and Physician Billing, and acts as a key liaison for Care Management, Clinical Denials, and Revenue Cycle on payer and contract matters. The Director also provides leadership on contracting-related organizational and industry changes and advocates for the Network’s payer, employed physician, and integrated-network contracting strategies. This remote position requires the employee to be located in Arizona and to come onsite one to two times per month. The schedule is Monday through Friday, days.

Requirements

Bachelor’s degree in Business Administration, Health Administration, Finance, or a health-related field.
At least 5 years of hospital or health plan and physician contracting experience, including contract analysis and contract negotiation.
Demonstrated management experience in contract negotiation and business development in a health plan and hospital setting, including physician contracting.
Must be located in Arizona.
Ability to come onsite one to two times per month.

Nice To Haves

Master’s degree in Business or Health Administration.
Hospital operations experience.
Knowledge of government payer programs.
Clinical background.

Responsibilities

Develop payor contracting strategies with senior management for Network facilities, employed physicians, home health, joint ventures, ambulatory care, FQHCs, clinically integrated networks, and other services, using fee-for-service, bundled payment, or risk-sharing arrangements.
Analyze payor and employed physician contracts for utilization, operational trends, and profitability; present findings to senior management and Network leaders to inform decisions, strategy, operational efficiencies, and business initiatives.
Lead the Reimbursement Team, setting Network payor strategy and overseeing reimbursement negotiations and trends.
Direct and manage contract negotiations and payor relationships to maximize Network revenue, including negotiations with payor senior and executive management.
Develop and implement contracting policies and procedures to optimize patient flow and pricing while decreasing payor denials.
Market existing and new health services to payers; work with medical leaders and service-line directors to explain service offerings and establish rate structures that balance profitability and transparency.
Recommend and oversee information systems for expected payor reimbursement and related activities, including denials, and provide information on contract and business performance.
Develop and manage databases that provide online access to contract language and payer information, and support consistent interpretation of rates and payment methodologies for Revenue Cycle and Physician Billing.
Develop and direct projects that integrate successful payor contracting strategies throughout the Network; lead cross-departmental efforts to advance contracting initiatives and market share.
Consult with the employed medical group and Physician Billing on payer relationships, contracting, and reimbursement for employed physicians; help reduce administrative costs and maximize payer payment.
Collaborate with Revenue Cycle to accelerate cash flow and improve timely, accurate payer reimbursement; work with external organizations and government relations on legislation, data, and reporting.
Work with Enterprise Analytics and Physician Billing to develop and maintain electronic payer and employed physician utilization and revenue information for forecasting and contract revenue trends.
Advise Finance on annual revenue budget development related to payers and participate in ongoing and annual charge master review.
Develop management staff knowledge of payor contracting through networking and training; consult with Care Coordination/Case Management, Clinical Denials, and Clinical Documentation Improvement on payer issues and utilization management information for contracts.
Develop individual Letters of Agreement for specific patients as required.
Supervise and develop the contracting team, foster cross-training with Network Development, plan and revise work assignments, interview and select personnel, recommend personnel actions, and address employee issues and discipline as appropriate.