Director, Payor Contracting

Healthcare Outcomes Performance Co. (HOPCo) • Phoenix, AZ

28d • Onsite

About The Position

The Director, Payor Contracting is responsible for developing and maintaining positive and effective relationships with internal and external customers, serving as the primary contracting liaison between contracted Payors and providers. This role involves conducting comprehensive contract analysis and negotiations with Payors, covering aspects such as rates, payment methodologies, contract language, and value-based payment programs, all in adherence to internal control processes. The Director will also contribute to Payor reimbursement analysis to inform strategies for maximizing health plan reimbursement, research and recommend new contracting opportunities to executive leadership, ensure compliance across all business and contractual relationships, and identify and communicate market trends or potential issues to the management team. Additional duties may be assigned.

Requirements

• Bachelor’s Degree in Business, Finance or Healthcare Administration required.
• Proven working knowledge of provider financial issues, complex contracting options, financial/contracting arrangements and regulatory requirements.
• 5-7 years related experience and comprehensive level of negotiating skills with successful track record negotiating contracts with payors.
• Strong communication, critical thinking, problem resolution and interpersonal skills.
• Solid understanding of industry dynamics required.
• Familiarity with managed care products and services, medical cost trend analysis, including analysis of physician contracts, utilization, and costs.
• Must have prior experience working with managed care contracting modeling.
• Familiar with a variety of concepts, practices, and procedures in the field of managed care.
• Must be able to problem solve and come forward with recommendations.
• Must be able to stay on task with minimal supervision.
• Excellent critical thinking, troubleshooting, and analytical skills.
• Knowledge of payor reimbursement.
• Managed care contracting.
• Market and industry knowledge.
• Strong verbal and written communication skills.
• Strong organizational skills and careful attention to detail.
• Advance computer skills.
• Ability to analyze problems and interpret information.
• Able and to prioritize and reprioritize, as necessary.
• Ability to work independently, and as part of a team.
• Ability to multi-task, manages multiple projects, and meets tight deadlines.

Responsibilities

• Develop and maintain positive, effective relationships with internal and external customers and serve as the contracting liaison between contracted Payors and providers.
• Conduct contract analysis and negotiations with Payors on behalf of providers including rates, payment methodologies, contract language and value-based payment programs in accordance with internal control processes for contract review, approval and signature.
• Participate in Payor reimbursement analysis that can be routinely updated and maintained as a baseline for strategies to maximize health plan reimbursement.
• Research and make recommendations to executive leadership in regard to payor contracting opportunities in new and existing geographic service area.
• Ensure compliance in all business and contractual relationships.
• Identify and communicate trends and/or potential issues to management team.
• Other duties and responsibilities as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Director