Sr. Director - Payer Contracting

Astrana Health, Inc.•Monterey Park, CA

17h•$175,000 - $185,000•Hybrid

About The Position

We are currently seeking a highly motivated Senior Director – Payer Contracting. This is a hybrid role where the expectation is to work both in office 2 to 3 days in Orange, CA and Monterey Park, CA and at home on a weekly basis. This role will work closely with the SVP of Payer Contracting to develop and execute on managed care contracting strategies and negotiations. You will be responsible for identifying and evaluating payor and provider opportunities, determining optimal reimbursement rates, drafting and managing contracts, serving as an organizational subject matter expert on existing capitation and fee for service agreements for Multi-State Market and other states, and researching and resolving payor and provider issues.

Requirements

Master’s degree and/or Bachelor’s degree or BS/BA in business administration or health care related field of study or equivalent years of experience
Direct experience leading health plan/provider negotiations
Experience with financial models analyzing health plan agreements
At least 10 years prior experience in contracting

Nice To Haves

Experience in risk-based contracting and associated financial analysis strongly preferred
Ability to close deals under tight deadlines-sense of urgency
Comfortable in negotiating all types contracts from start to finish within defined parameters
Experience with FFS, capitation, and risk sharing arrangements
Experience with government programs (Medicare, Medi-Cal, D-SNP)
Experience working with health plan, provider and hospital counterparts
Knowledge of California payer, Institutional and IPA contracting
Successful experience negotiating contracts for all Lines of Business (Commercial, Medicare, Medicaid, and Accountable Care)
Project management skills/experience
Advanced MS Word capabilities: find & replace, redlining, comment insertion, track changes and document compare
Proficient in MS Excel (including use of functions and pivot tables) and PowerPoint software
Demonstrated ability to work with effectively with multiple different areas within an organization (both internal and external)
Proven ability to work effectively both independently and with teams in a dynamic and fast paced environment
Proven leadership/strategy and organizational skills are required, as well as excellent written and verbal communication skills
Strong interpersonal and communication skills and ability to work effectively with a wide range of constituencies
Experience with healthcare operations, systems, and financial/claims data analysis

Responsibilities

Leads contract negotiations, as assigned, including risk-based agreements, fee-for-service negotiations, pay for performance programs, and ACO agreements with health plans
Manages contractual relationships with payers and internal stakeholders
Reviews health plan contract language and is familiar with payor, medical group/IPA, and hospital/ancillary contract language and reimbursement mechanisms
Circulates draft contract terms/language to various internal departments for review & approval
Applies knowledge of healthcare delivery system, IPA operations, managed care, healthcare laws in assisting with the development of contracting strategies
Answers and/or resolves inquiries from health plans or internal departments in a timely manner
Establishes good working relationships with health plan representatives and internal teams
Develops tools (e.g., dashboards, grids, tables, summaries) to provide organizational leadership key contract data
Utilizes applicable financial tools and reports to evaluate performance of current contracts
Interacts and consults with Network Pricing team to evaluate different financial arrangements and recommend applicable payment methodologies
Ensures compliance and consistent contracting across the enterprise.
Manages various ad-hoc project requests with short turnaround time.
Performs other duties as assigned.