Director, Payor Contracting

Healthcare Outcomes Performance Company • Phoenix, AZ

1d

About The Position

ESSENTIAL FUNCTIONS · 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. EDUCATION · Bachelor’s Degree in Business, Finance or Healthcare Administration required. EXPERIENCE · 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. REQUIREMENTS · 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 · Knowledge of payor reimbursement. · Managed care contracting. · Market and industry knowledge. SKILLS · Strong verbal and written communication skills. · Strong organizational skills and careful attention to detail. · Advance computer skills. ABILITIES · 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. ENVIRONMENTAL WORKING CONDITIONS · Normal office environment. · Some travel within community. PHYSICAL/MENTAL DEMANDS · Requires sitting and standing associated with a normal office environment. · Some bending and stretching required. · Manual dexterity using a calculator and computer keyboard.

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.
• Requires sitting and standing associated with a normal office environment.
• Some bending and stretching required.
• Manual dexterity using a calculator and computer keyboard.

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
• Number of Employees: 101-250 employees