Manager of Payor Contracting | South Portland, ME

InterMed, P.A.•South Portland, ME

21d

About The Position

CORE RESPONSIBILITIES: Contract Negotiations & Support of Overall Strategy Negotiate and contract to optimize reimbursement structures and rates with payor partners, including the facilitation of the approval and signature process. Negotiate language and terms and conditions across all payor contracts, primarily value-based Work directly from guidance of Director of Payor Contracting to support a work plan/strategy Work to support system strategic initiatives, as directed by the Director of Payor Contracting Develop guidelines for best practice items and key contractual acceptable language to support negotiations with a consistent approach where possible Amend existing agreements to find opportunities for coverage of new services or to enhance current contract terms in terms of new language or operational needs Leverage internal BI/RCM data to assure negotiated rates and rate requests maintain our competitive position Stay informed on market trends and healthcare industry shifts to help inform overall payor strategy and successful negotiations Outcomes Management & Operational Support Recommend necessary strategies to leadership based on contract performance Work closely with RCM on operational issues related to Payor Contracting - includes attendance at Payor Ops and Joint Operating Committee (JOC) meetings and support to RCM leadership to help monitor financial performance of assigned payor contracts versus expectations Partner with teams directly responsible for validation of payments and/or policy monitoring Identify and develop strategies to mitigate risks and sources of exposure in payor contracts Proactively work with BI and other data teams to refine the reporting of contract performance, analysis, and modeling tools Prepare relevant recommendations and reports for committees and boards, as required Stakeholder Support & Engagement Establish and maintain relationships with payors contacts and help facilitate overall relations Provide education on new agreements - via written communication or presentations - that may impact stakeholders. Address leadership data needs resulting from new/modified agreements Work with other internal partners on supporting/leading select system strategies where Contracting can drive specific change or help develop new processes Contribute to communications and education regarding Payor Contracting utilizing tools such as the electronic newsletter, educational sessions, or other appropriate forums as needed Interact with providers to identify payor trends requiring action or escalation Continue to grow knowledge of market trends via conferences, continuing education, etc. Maintains strict confidentiality in alignment with HIPAA (Health Insurance Portability and Accountability) guidelines and InterMed policies.  Perform other duties to support the mission, vision and values of InterMed.  MISSIONS AND VALUES:  Follows InterMed’s mission to provide patient-centered primary care, putting the patient first to deliver high quality, high value care. Provide the highest quality care to our patients with a level of service that exceeds their expectations. Maintain a positive attitude and always treat our patients and each other with dignity and respect. Insist on honesty and integrity from each other and our business partners. Make teamwork a core component of our relationships between physicians, staff, and patients. Embrace change to better serve our patients. Use business practices that feature individual accountability and group responsibility to ensure delivery of high value healthcare. Have fun as we carry out our mission to serve. KNOWLEDGE, SKILLS, AND ABILITIES:

Requirements

Bachelor's degree required. Preferred areas of study include Healthcare Administration, Business, Finance, or another related field.
Minimum 3 years of experience in a similar or related role such as managed care/ACO contracting, provider/payor relations, project management, physician organization, hospital organization or health plan.
Demonstrated experience in negotiating and managing complex payor contracts
Proficiency in Microsoft Office suite
Strong organizational and time management skills to help prioritize tasks and meet deadlines
The ability to build strong relationships with internal/external stakeholders
Strong analytical and problem-solving skills
The ability to interpret and present operational and financial impacts related to Payor contracts
Strong interpersonal, communication (written/verbal) and presentation skills
Awareness of relevant healthcare industry trends

Nice To Haves

Experience in value-based healthcare strongly preferred

Responsibilities

Negotiate and contract to optimize reimbursement structures and rates with payor partners, including the facilitation of the approval and signature process.
Negotiate language and terms and conditions across all payor contracts, primarily value-based
Work directly from guidance of Director of Payor Contracting to support a work plan/strategy
Work to support system strategic initiatives, as directed by the Director of Payor Contracting
Develop guidelines for best practice items and key contractual acceptable language to support negotiations with a consistent approach where possible
Amend existing agreements to find opportunities for coverage of new services or to enhance current contract terms in terms of new language or operational needs
Leverage internal BI/RCM data to assure negotiated rates and rate requests maintain our competitive position
Stay informed on market trends and healthcare industry shifts to help inform overall payor strategy and successful negotiations
Recommend necessary strategies to leadership based on contract performance
Work closely with RCM on operational issues related to Payor Contracting - includes attendance at Payor Ops and Joint Operating Committee (JOC) meetings and support to RCM leadership to help monitor financial performance of assigned payor contracts versus expectations
Partner with teams directly responsible for validation of payments and/or policy monitoring
Identify and develop strategies to mitigate risks and sources of exposure in payor contracts
Proactively work with BI and other data teams to refine the reporting of contract performance, analysis, and modeling tools
Prepare relevant recommendations and reports for committees and boards, as required
Establish and maintain relationships with payors contacts and help facilitate overall relations
Provide education on new agreements - via written communication or presentations - that may impact stakeholders.
Address leadership data needs resulting from new/modified agreements
Work with other internal partners on supporting/leading select system strategies where Contracting can drive specific change or help develop new processes
Contribute to communications and education regarding Payor Contracting utilizing tools such as the electronic newsletter, educational sessions, or other appropriate forums as needed
Interact with providers to identify payor trends requiring action or escalation
Continue to grow knowledge of market trends via conferences, continuing education, etc.
Maintains strict confidentiality in alignment with HIPAA (Health Insurance Portability and Accountability) guidelines and InterMed policies.
Perform other duties to support the mission, vision and values of InterMed.