Vice President Managed Care and Payer Relations - FT - Day Shift

ECMC•Buffalo, NY

9d•Onsite

About The Position

The work involves planning, coordinating, directing, and managing the day-to-day relationships with local and non-local health insurance and managed care plans at the Erie County Medical Center Corporation (ECMCC). The incumbent establishes and maintains relationships with health insurance plan leaders, develops and implements strategies, short and long-term goals, objectives and action plans for the Managed Care Department, with the intended outcome of directly contributing to the revenue growth, earnings performance, and achievement of strategic objectives at ECMCC. The work is performed under the general direction of the Chief Financial Officer. Supervision is exercised over lower-level administrative and professional staff. Performs related work as required.

Requirements

Thorough knowledge of the principles, practices and terminology in the field of health care administration
Thorough knowledge of the principles, practices and terminology of Managed Care administration including contracting and payer reimbursement
Thorough knowledge of federal, state and local regulations and rules as they relate to Managed Care
Ability to plan, implement and evaluate financial and business objectives
Ability to prepare and present complex comprehensive financial reports
Ability to conduct negotiations
Ability to manage multiple priorities
Ability to organize, direct and evaluate work of assigned staff
Ability to communicate effectively both orally and in writing
Ability to maintain effective working relationships with third-party payers, ECMCC management and staff, physicians, public and private organizations, etc.
Ability to use a variety of software applications
Strategic and tactical thinking
Sound professional judgment
Leadership
Initiative
Positive attitude
Confidentiality
Capable of performing the essential functions of the position with or without reasonable accommodation
Possession of a Master’s Degree in Business, Public or Hospital Administration or closely related field and seven (7) years of healthcare experience, of which five (5) years must include experience with Managed Care contracting
OR Possession of a Bachelor’s Degree in Business, Public or Hospital Administration or closely related field and nine (9) years of healthcare experience, of which five (5) years must include experience with Managed Care contracting

Responsibilities

Works collaboratively with ECMCC leadership to develop and implement the Managed Care contracting strategies, contracts, renewals and alternative payment models which serve as the basis for Managed Care activities
Leads the ECMCC Managed Care negotiating team
Develops and coordinates payer contract strategies and develops and manages payer relationships
Works collaboratively with others within the Finance Department to develop and produce financial forecasts designed to meet/exceed revenue and earnings objectives
Implements processes and communication strategies for decision-making to include active involvement of ECMCC leadership and key stakeholders
Collaborates with Executive Management, Medical Staff and Service Line Leadership to identify and coordinate strategies and action plans designed to increase revenue and meet earnings growth objectives
Works closely with ECMCC counsel on modifying contract language and terms and conditions to align with ECMCC practices
Communicates and regularly collaborates with the Utilization Management department on authorizations and payer practices, policies and procedures
Regularly interacts with Revenue Cycle, Case Management and Health Information personnel on notifications, denials, documentation and appeals
Develops and maintains contacts with federal, state and local agencies associated with Managed Care
Ensures compliance with federal, state and local regulations and rules as they relate to Managed Care
Manages portfolio of Managed Care contracts and associated revenue to meet/exceed ECMCC business objectives
Evaluates and reports on status of goals and objectives in relation to established Managed Care contracting renewals and other activity
Identifies Managed Care growth opportunities by researching and evaluating the market, contracts and other applicable factors to increase market share, maximize revenues and meet/exceed overall business goals and objectives
Monitors industry trends and potential changes to federal, state and local regulations and rules as they relate to healthcare
Develops, tests and implements value-based Managed Care contracts and associated reimbursement methodologies (“non-FFS”) by closely working with Population Health personnel and Great Lakes Integrated Network (GLIN), ECMCC’s Clinically Integrated Network
Collaborates with legal and/or regulatory partners to achieve a high-level of compliance
Develops and administers presentations to internal and external audiences
Participates in activities related to the Great Lakes Integrated Network (GLIN) as assigned
Regularly interacts with credentialing and re-credentialing personnel and ensures all documentation related to facility credentialing is up to date and current
Negotiates Single Case Agreements (SCA) for patients who are associated with payers not contracted with ECMCC
Attends required meetings, participates in committees as required and maintains membership in professional organizations