Director of Managed Care Contracting and Anlaytics

Sturdy Memorial Hospital•Attleboro, MA

2d•$139,296 - $219,511

About The Position

The Sturdy Health Director of Managed Care Contracting is responsible for the strategy, negotiation, and monitoring of third-party contracts. The director works with Revenue Cycle and Population Health teams to help ensure the hospital and physician group are paid according to contract and succeed under value-based and risk arrangements. The director serves as the primary liaison with third-party payers regarding contract terms and contributes to decisions about plan participation. The role oversees third-party contracting across the system, including hospitals, the physician group, and value-based arrangements. It leads negotiations, monitors payer performance and reimbursement, supports contract compliance and interpretation, and partners with executive leadership and internal teams to develop contracting strategies and improve financial performance. The director also supports analytics, revenue valuation, year-end accounting entries, and audit work.

Requirements

Bachelor’s degree in Healthcare Administration, Finance, Business Administration, or a related field.
At least 5 years of managed care contracting and negotiation experience.
Strong negotiation, analytical, and relationship management skills.
Extensive knowledge of hospital and physician provider payment arrangements and methods.
Deep knowledge of laws and regulations pertaining to the healthcare industry.
Ability to communicate effectively, orally and in writing, with a wide variety of individuals and groups.
Demonstrated ability to independently handle multiple unique, sensitive, and complex matters with minimal supervision and oversight.
Ability to relate to people in a manner that gains support and promotes confidence.
Ability to maintain confidentiality and carry out assignments proficiently and professionally.
Commitment to the philosophy, mission, and values of Sturdy Health.
Ability to perform the essential functions, including required work hours, locations, and physical demands, with or without reasonable accommodation, without posing a direct threat to workplace health and safety.

Nice To Haves

Graduate degree.

Responsibilities

Oversee third-party contracting across the system, including hospital, physician group, and value-based arrangements.
Lead negotiations with third-party insurers to secure market-competitive payment rates for hospital and physician services.
Collaborate with executive leadership to align network contracting strategies with organizational goals, and monitor market dynamics to inform strategy.
Develop and execute contracting strategies that anticipate market shifts, payer policy changes, and regulatory developments.
Build and maintain positive relationships with third-party insurers, promote transparency and accountability, resolve issues, and support effective negotiations on behalf of Sturdy Health.
Monitor and analyze third-party payments and payer performance, utilization trends, and reimbursement outcomes to assess contract compliance and identify improvement opportunities and risks.
Ensure accurate claims pricing through Strata contract configuration.
Ensure contracting activities comply with federal, state, and accreditation requirements.
Educate staff about contract parameters and changes, and communicate complex concepts to executives, physicians, and cross-functional partners.
Serve as the primary contact and resource for contract interpretation and managed care reimbursement issues.
Work with internal clients to resolve reimbursement issues, recommend process improvements, and propose contract changes to improve reimbursement and contract performance.
Partner with the Population Health Team to develop, value, and track value-based programs, including shared savings, bundled payments, downside risk, and capitation.
Monitor performance programs and payer risk arrangements to support strategic objectives and maximize financial performance.
Work with Budget and Decision Support to develop accurate projections and analytics supporting hospital operations and strategic decisions.
Perform or review analyses related to payer policy changes, regulatory updates, and reimbursement shifts, including analyses supporting negotiation strategy.
Assist with monthly net revenue and accounts receivable valuation.
Prepare year-end revenue-related general ledger entries and audit work papers, and respond to audit questions as appropriate.
Treat patients, colleagues, and visitors with dignity and respect while being sensitive to differing needs, backgrounds, characteristics, and cultures.