Director - Managed Care Payor Contracting

HonorHealth•Scottsdale, AZ

1d•Remote

About The Position

The Director Payor Contracting develops payor contracting strategies with senior management for HonorHealth’s Network, covering health plans, government entities, employers, facilities, employed physicians, home health, joint ventures, ambulatory care, Federally Qualified Health Centers, clinically integrated networks, and other arrangements. Contracting approaches may include fee-for-service, bundled payments, and risk sharing. The director manages the Network contracting process, including pricing, negotiations, reimbursement, and profitability, and leads the Reimbursement Team responsible for Network payor strategy and reimbursement trends. This role analyzes payor and employed-physician contracts, utilization, operational trends, and profitability, and presents findings to senior management to inform organizational decisions, strategy, operational efficiencies, and new business initiatives. The director works with Enterprise Analytics, Physician Billing, Finance, Revenue Cycle, clinical and administrative leaders, and external payors to develop contracting information, operationalize contracts, support accurate reimbursement, reduce denials and costs, and accelerate cash flow. The position also advises the employed medical group and Physician Billing on physician contracting, reimbursement strategies, payer relationships, utilization, and profitability. The director builds relationships with payors and internal stakeholders, negotiates with payor senior and executive management, develops contracting policies and procedures, supports marketing of health services to payors, and works to expand Network market share. The role provides access to contract language and payer information through database development and management; supports revenue forecasting, budgeting, and charge master review; and coordinates responses to legislation with external organizations and internal government relations. The director also consults with Care Coordination/Case Management, Clinical Denials, and Clinical Documentation Improvement, develops individual Letters of Agreement as needed, and supervises and develops the contracting team. The position is remote for candidates located in Arizona, with on-site attendance required one to two times per month at HonorHealth’s Scottsdale location. 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.
Attend the Scottsdale worksite 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, and other Network services and entities.
Analyze payor and employed-physician contracts for utilization, operational trends, and profitability, and present findings to Network leadership.
Lead the Reimbursement Team and oversee Network payor strategy, reimbursement negotiations, and trends.
Direct contract negotiations and build payor relationships to maximize Network revenue.
Develop and implement contracting policies and procedures to optimize patient flow and pricing while decreasing payor denials.
Market existing and new health services to the payor community and work with medical leaders and service-line directors to establish rate structures.
Recommend and oversee information systems for managing expected payor reimbursement, denials, contract performance, and business performance.
Develop and manage a database of contract language and payer information, including consistent interpretation of rates and payment methodologies for Revenue Cycle and Physician Billing.
Lead projects and cross-functional efforts to integrate contracting strategies and initiatives across the Network.
Advise the employed medical group and Physician Billing on physician payer relationships, contracting, reimbursement, utilization, and profitability.
Collaborate with Revenue Cycle to accelerate cash flow and improve timely and accurate reimbursement.
Work with external organizations and internal government relations on legislation, data, and reports.
Work with Enterprise Analytics and Physician Billing to develop and maintain payer and employed-physician utilization and revenue information for forecasting and trending contract revenue.
Consult with Finance on annual revenue budget development and participate in ongoing and annual charge master review.
Develop management staff knowledge of payor contracting issues through networking and training.
Consult with Care Coordination/Case Management, Clinical Denials, and Clinical Documentation Improvement on payer matters and utilization management information.
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, and participate in personnel selection and employment actions.