Director, Payer Strategy & Contracting
About The Position
Reporting directly to the Assistant Vice President, Payer Strategy and Contracting, the Director of Payer Strategy and Contracting will be primarily responsible for the negotiation, implementation and oversight of payer contracts and relationships. The Director will work closely with the analytics team to model all contract proposals including fee-for-service and value-based arrangements (i.e., shared savings, bundles, etc.). They will work closely with the contract operations team to troubleshoot contract operational issues and assist where necessary to bring them to resolution using their understanding of the underlying contracts as well as by leveraging their payer relationships.
Requirements
- Experience (7+ years) in payer or provider contracting and/or provider network oversight.
- Experience managing and leading a professional team.
- Experience dealing with payers, patient financial services professionals, providers, and their billing staff.
- Possesses key payer contacts and knowledge of payer contracting.
- Is detail oriented.
- Knowledge of the healthcare industry and payer reimbursement methodologies (both hospital and physician).
- Ability to work independently and collaboratively to solve complex problems.
- The ability to influence and motivate others, as well as work collaboratively within a multi-stakeholder environment is required.
- Excellent verbal and written communication skills.
- Excellent organizational and multi-tasking skills.
- Is professional when dealing with stakeholders.
- Uses good judgement and takes a thoughtful approach to resolving and communicating issues.
Nice To Haves
- Major teaching/surgical hospital experience or health plan experience is highly desirable.
Responsibilities
- Meets with organizational leadership and stakeholders to ascertain and develop strategic payer contracting goals.
- Negotiates contracts ensuring financial and strategic goals are translated into contractual language accordingly.
- Analyzes payer contract proposals in conjunction with the analytics team to ensure contracts meet financial goals.
- Works closely with the legal team to review and edit contracts as appropriate.
- Ensures internal stakeholders are aware of contract terms, reimbursement rates, and payer policies and that contract terms are appropriately communicated/translated into front and back-end processes.
- Works closely with the revenue cycle teams to ensure contracts are loaded appropriately into billing and decision support systems.
- Works closely with the contract operations team, UM/clinical denials team, and revenue cycle teams to identify trends and opportunities in outstanding accounts receivable.
- Escalates issues as necessary to payer contacts for resolution.
- In conjunction with contract operations, recommends escalation through senior management as appropriate.
- Identifies trends/patterned issues to aid in contract renegotiations.
- Assesses contract administrative terms and advises leadership accordingly on measures of contract performance.
- Maintains up to date knowledge on the healthcare market, specifically in regard to payer policies and reimbursement trends.
- Possesses strong leadership skills and demonstrates capability to inspire staff to pursue excellence in goals and productivity; capable of coaching and improving staff in need of professional development.
- Places high priority on overall team performance.
- Additional responsibilities as required to accomplish departmental goals.
Benefits
- additional benefits consistent with the role
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What This Job Offers
Job Type
Full-time
Career Level
Director
