Senior Director, Provider Contracting - Denver Health Medical Plan (Must Live in Colorado. Weekly On Site Requirement)

Denver Health•Denver, CO

1d•$143,800 - $237,400•Hybrid

About The Position

We are recruiting for a mission-driven Senior Director, Provider Contracting - Denver Health Medical Plan (Must Live in Colorado. Weekly On Site Requirement) to join our team! We're with you for life’s journey. At Denver Health, purpose isn’t just something we believe in—it’s something we live every day, for life’s journey. Our Values Respect | Belonging | Accountability | Transparency Department Managed Care Administration Must Live in Colorado This is a hybrid role located in Denver, Colorado with a requirement of being in the office 3 days per week.

Requirements

Bachelor's Degree, concentration in Finance, Accounting, Business, Management, Healthcare Administration related field required
10+ years Contract Management demonstrated experience required; provider contracting experience preferred required
4-6 years manager experience required, preferably in healthcare required
Strong knowledge of Medicaid, Commercial ACA, Medicare, and CHP+ lines of business is required
Knowledge of CPT, ICD-9 and 10, DRG, HCPCS, RBRVS, bundled payments, risk-sharing, and provider capitation is essential
Extensive knowledge and experience with Medicare/Medicaid regulations
Excellent negotiating skills and proficiency in utilizing and interpreting financial models and analysis
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
Must Live in Colorado

Responsibilities

Oversee organizational contract development and management activities and enforce organizational principles of integrity and compliance (15%)
Develop standards for contracts, including payment terms, general language and provisions based on strategy discussions, senior management input and organizational needs (15%)
Evaluate rate proposals, changes to reimbursement methodologies and conduct related analyses to ensure continued financial viability of the contract (10%)
Ensure contracts and proposals are properly entered into organizational databases to measure, track and monitor utilization and financial performance (10%)
Negotiate single case agreements as needed (5%)
Serve as primary organizational contact during provider contract negotiations (10%)
Identifies network needs and manages the recruitment and contracting process for new providers and institutions (5%)
Ensure prompt resolution of all escalated concerns or issues from the Plan’s provider network (5%)
Participate in JOC meetings with providers to address contractual payment issues and trends (5%)
Validate the proper uploading, adjudication, and pricing of claims (5%)
Maintain knowledge and understanding of healthcare industry trends, standards, and current events relative to provider contracting, network administration and market (5%)
Carry 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 disciplining employees; addressing complaints and resolving problems (5%)
Special projects/ other duties as assigned by the CFO (5%)

Benefits

Generous paid time off, fully paid parental leave, exceptional retirement contributions, comprehensive health coverage, and nationally recognized well-being programs.
Tuition assistance, career advancement pathways, and professional development.
Loan forgiveness eligibility and employer contributions.
Paid time off starting at 28 days per year, inclusive of vacation, personal/sick, and 7 Holidays
100% paid parental leave up to 6 weeks
Immediate eligibility for retirement plans with employer contribution up to 9.5%
Generous medical, dental, vision plans in addition to employer paid disability and life insurance.
Comprehensive well-being programs including on-site employee fitness center located on Denver Health main campus and nationally recognized RESTORE Center
Free RTD EcoPass (public transportation)
Childcare discount programs & exclusive perks on large brands, travel, and more
Tuition reimbursement & assistance
Education, coaching, and professional development opportunities through the Workforce Development Center (WFDC) that support internal career growth and advancement pathways
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