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Director, Payer Contracting

Brentwood, TN, USA | Sound Physicians

  • Industry:
    Healthcare - Hospitals
  • Position Type:
    Full-Time
  • Functions:
    General Management
    Legal / Compliance
  • Experience:
    10-12 years
Job Description:
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Sound Physicians is a leading physician partner to hospitals, health plans, physician groups, and post-acute providers seeking to transform outcomes for acute episodes of care.For 20 years our high-performing and affordable care models have combined physician leadership, clinical process, technology and analytics to consistently improve clinical and financial performance.We are pioneers in value, working together with our partners and community providers to bridge gaps in care, from hospital to home.


Sound Physicians offers a competitive benefits package inclusive of the items below, and more:



  • Medical insurance, Dental insurance and Vision insurance

  • Health care and dependent care flexible spending account

  • 401(k) retirement savings plan with a company match

  • Paid time off (PTO) as needed for vacation, illness, personal days or otherwise in accordance with Sound's PTO policy

  • Ten company-paid holidays per year


Position Summary:


Under the strategic direction of the VP, Payer Contracting, The Director, Payer Contracting is responsible is responsible for all duties related to managing payer relationships, negotiations, financial modeling and tracking of new and existing payer contracts for a specific geographic region of the country with the primary goals of a) to maximize commercial contract net revenue and b) proactively identify opportunities for the department to increase revenue, save work load, or identify missed opportunities. 


In addition to negotiating contracts, this position will involve developing and implementing strategic relationships with major Payers on a regional and/or national level while working in a matrixed manner with members of the Revenue Cycle, Business Development, Field Operations, Implementation, Financial Modeling, Payer Contracting Operations, Provider Enrollment and Value Based teams regarding contracting, financial and strategic objectives affecting their specific geographical region and the company.


Essential Duties and Responsibilities:



  • Responsible for the managing a team(s) of negotiators and regional oversight of the strategic development, coordination and analysis of managed care agreements (Commercial, Medicare, Medicaid, Exchange and Value Based) including rate development and contract negotiations while understanding key decision points and presenting them clearly when a decision needs to be made.

  • Responsible for the development and management of their of their annual regional contracting budget

  • Understands the nature of the role and organization and will flex, as needed, to mold their role to the organizations needs without being asked

  • Generate necessary reports for the VP and executive team; read/report/monitor subordinate reports and performance

  • Assess and report progress in meeting department objectives (Budget, Strategic, etc.)

  • Understands not only contracting end to end but also understands the whole Revenue Cycle continuum as well as good working knowledge of Health Plan operations

  • Mentor Sr. Payer Contracting Managers, Payer Contracting Managers and Payer Contracting Liaisons, as needed, in all aspects of payer contracting activities

  • Performs other related duties and special projects as assigned.


Special Knowledge, Skills, Abilities, Training or Special Licenses/ Certifications Needed to Perform This Job: 



  • Excellent organizational abilities, written and oral communication skills

  • Exceptional commercial contract negotiation skills and experience with physician contracts including excellent knowledge of Medicare reimbursement methodologies, case rate reimbursement methodologies, fee schedule development, utilizing financial models and analysis in negotiating rates with Payers

  • Working knowledge and experience of and with value based care reimbursement models and the life cycle of value based care agreements

  • Working knowledge of current policies and guidelines that affect contracts, rate development, legislative regulations etc. in the managed care environment

  • Creative and persistent problem solver with an ability to present solutions to complex problems

  • Attention to detail and accuracy with an ability to summarize difficult concepts to all levels of management in short, consumable bites and/ or concepts

  • Client service oriented (both internal and external), harnesses soft skills in communicating difficult decisions and ensuring various levels of colleagues understand messaging

  • Ability to interact and communicate with individuals at all levels of organization

  • Strong interpersonal skills to handle sensitive situations and confidential information

  • Ability to multi-task and prioritize workload in a fast-paced environment

  • Anticipates needs three steps ahead and develops mitigation prior to the need

  • Ability work in a group setting

  • Ability to complete projects independently within established timeframes

  • Proficiency with Microsoft Office Suite


 Education / Experience:


Education



  • Required: Bachelor’s degree or equivalent experience


Experience


Preferred – 10+ years in Commercial Managed Care, Payer, Hospital, ASC settings with an emphasis on contract negotiations (Hospital, ASC and/or Physicians), including 5+ years of experience managing contractors or contracting teams, contracting budgets and strategic contracting projects (commercial network builds, market corrections, etc.)


Required - 7 - 10+ years in Commercial Managed Care, Payer, Hospital, ASC settings with an emphasis on contract negotiations (Hospital, ASC and/or Physicians), including 3-5 years of experience managing contractors or contracting teams, contracting budgets and strategic contracting projects (commercial network builds, market corrections, etc.)


Required: Advanced understanding/knowledge of computer data entry, All Microsoft Office suite products, and ability to navigate through any business related software


List Special Job or Environmental Conditions:



  • Indoor office environment


Travel required: 2-10 trips per year


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