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Director of Payer Contracting

Nashville, TN, USA | Leading Healthcare - Hospitals Company

  • Industry:
    Healthcare - Hospitals
  • Position Type:
  • Functions:
    General Management
    Biotech/R&D/Science
  • Experience:
    5-7 years
Job Description:
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Responsible for proactively developing and executing contract strategies and tactics for certain national health plans, leading execution of regional contract strategies as aligned (payors, health systems, ACOs), and improving overall performance of assigned portfolio under the supervision of the SVP of Payor Relations and in collaboration with regional leadership and the Manager, Payor Contracting.


Essential Functions:

Improves performance of contract portfolio by monitoring overall contract performance (Contracts, GM, EBITDA, Mix) productivity, pay for performance, and cash flow from contractual agreements and by reviewing management reports of all company payor contracting, billing, collection and quality efforts.Seeks to understand any variance in actual vs. expected outcomes, recommends interventions and takes appropriate action.

Models contract proposals, drafts contract terms, reviews and recommends strategy, negotiates, and finalizes new/renewed/renegotiated health plan, health system, ACO or other payor agreements.

Identifies strategic opportunities to collaborate with payors on value based contracting initiatives to improve overall quality and patient engagement, favorably impact total cost of care, and improve reimbursement opportunities. 

Conducts market research as required (local, regional, national, CMS) to develop informed strategies.

Maintains good relationships with vendors, payors, and other third parties in order to enhance strategic relationships and opportunities. 

Produces and reports on contractual performance.Provides subject matter expertise and educational tools to company locations regarding participation in payor programs and contracts.

Monitors and maintains accurate payor files for timely and efficient reference and claim processing.

Monitors and evaluates employee performance. Holds employees accountable for the attainment of defined goals and objectives. Executes effective performance redirection when needed. Develops employees through coaching, mentoring, and formal/on the job training and development opportunities.


Qualifications:


Required:


Bachelor’s degree in Business or related field.

Six (6+) years’ experience in managed care contracting in the home health and hospice fields.

Demonstrated knowledge of managed care, including managed Medicare and Medicaid, and other payor’s guidelines and criteria for reimbursement.

Preferred:

Master’s degree in Business or related field.

Prior experience informing and leading contract strategies.

Prior experience communicating strategies and adjusting strategies based on feedback of stakeholders.

Prior experience in supervisory role. 

 

Travel:


Moderate degree of travel. 


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