Senior Director of Payor Contracting

Denver Health and Hospital Authority • Denver, CO

2d • $203,000 - $335,000

About The Position

Under the general supervision of the Chief Strategy Officer, the Senior Director of Payor Contracting is responsible for overseeing and carrying out the development, negotiation, preparation, documentation, and implementation of new and established contracts for facility and professional agreements with third party payers on behalf of Denver Health & Hospital Authority, including new programs and services. This role manages relationships with payers, including lead negotiations with assigned payers, establishing processes to monitor and evaluate payer performance, and to ensure compliance with all applicable regulatory and administrative requirements. This role shall include setting terms for and contracting for terms based on all reimbursement models in effect for or which may be become in effect for Denver Health, including, but not limited to payment arrangements which are fee-for-service, managed care, value-based, and gain/risk sharing. The Senior Director is accountable for negotiating contract language that aligns with all State and Federal laws/regulations and organizational policies and standards. This position is responsible for developing and maintaining revenue integrity functions consistent with the mission and vision of Denver Health & Hospital Authority.

Requirements

• Bachelor's Degree with concentration in Finance, Accounting, Business, Management, Healthcare Administration related field (required)
• 7-9 years Contract Management demonstrated experience with large Managed Care systems required (required)
• 1-3 years management experience, preferably in healthcare (required)
• Strong knowledge of Managed Care contracts is required.
• Advanced understanding of CPT, HCPCS, ICD-11 and various reimbursement methodologies such as Medicare/ Medicaid and third-party billing requirements.
• Extensive knowledge and experience with Medicare/ Medicaid regulations.
• Excellent negotiating skills and proficiency in utilizing and interpreting financial models and analysis.
• Experience with APC reimbursement, CMS rules and regulations, coding and billing compliance.
• Strong working knowledge of billing and collection processes and functions, charging processes and general revenue cycle management strategies and industry best practices.
• Requires high attention to detail, analytical and critical thinking, management skills, organization, prioritization and problem resolution.
• Excellent verbal and written communication, leadership, delegation, collaboration and interpersonal skills
• Ability to be resourceful, customer-service oriented and independently problem-solve is required.
• Working knowledge of the following information systems to include accessing information, updating, correcting and/ or deleting data. General knowledge related to various software applications and their capabilities. Microsoft Office applications: Word, Excel, Access, PowerPoint, Infor, and Outlook

Nice To Haves

• Juris Doctorate (preferred)

Responsibilities

• Oversees organizational contract development and management activities and enforce organizational principles of integrity and compliance 10%
• Develops standards for contracts, including payment terms, general language and provisions based on strategy discussions, senior management input and organizational needs 10%
• Evaluates rate proposals, changes to reimbursement methodologies and conduct related analyses to ensure continued financial viability of the contract 10%
• Ensures contracts and proposals are properly entered into organizational databases to measure, track and monitor utilization and financial performance of managed care contracts 10%
• Negotiates single case agreements to capture financial reimbursement from non-contracted entities 10%
• Serves as primary organizational contact during payer contract negotiations 10%
• Assists HPBS Department and internal customers with resolution of complex payer issues. Participate in JOC meetings with third party payers to address contractual payment issues and trends 5%
• Communicates and provides tools for contractual terms to other departments whose functions are necessary to the development, implementation and management of the provider arrangements. 5%
• Responsible for the credentialing of Denver Health facilities which includes all associated clinics and new business ventures 5%
• Maintains knowledge and understanding of healthcare industry trends, standards, and current events relative to provider contracting, network administration and market 5%
• Oversees the operation performance of a system-wide, service line-based Charge Review program to identify charge capture and DRG validation improvement opportunities to minimize revenue leakage 5%
• Provides data analytics and reporting to HPBS Department to identify potential process improvement in charge capture functions to maximize net reimbursement 5%
• Serves as the revenue integrity liaison for HPBS Department and revenue producing departments 5%
• Carries out supervisory responsibilities in accordance with the organization’s policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning and directing work; appraising performance; rewarding and performance-managing employees; addressing complaints and resolving problems 5%
• Special projects/other duties as assigned by the Chief Strategy Officer or as designated by the Chief Strategy Officer

Benefits

• Outstanding benefits including up to 27 paid days off per year, immediate retirement plan employer contribution up to 9.5%, and generous medical plans
• Free RTD EcoPass (public transportation)
• On-site employee fitness center and wellness classes
• Childcare discount programs & exclusive perks on large brands, travel, and more
• Tuition reimbursement & assistance
• Education & development opportunities including career pathways and coaching
• Professional clinical advancement program & shared governance
• Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program
• National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Number of Employees: 5,001-10,000 employees