Director of Payor Contracting

  • 51457
  • 11 Jul 2019
  • Pittsburgh, PA
  • Healthcare
  • Confidential
  • Amy Searles

Job Description

Director of Payor Contracting 

  • Lead Payor contracting efforts and support negotiations.

  • Work with senior leadership on the development and execution of complex payor contracting strategies to support the development of operational objectives.

  • Lead and drive project management, analysis of data, and strategic contract performance improvement initiatives to ensure that contractual terms are negotiated and ultimately met.

  • Use, create, and synthesize data to develop and drive internal contracting and departmental strategies.

  • Conduct analyses, management, accounting and budgeting of all payor contract agreements.

  • Serves as the third-party payer policy and reimbursement subject matter expert for acquisitions and development of new services.

  • Communicates with third party payors upon acquisition of clinics in order to either include them into existing contracts OR leverage their contracts for providers.

  • Establish effective lines of communications between Payers and Revenue Cycle in order to maximize contract effectiveness and ease of administration.

  • Negotiate settlements and resolves disputes with Payors.

  • Coordinates efforts to evaluate, prioritize, and resolve business units’ requests for assistance regarding payer agreements

  • Negotiates terms to support favorable performance under total cost of care and other highly collaborative arrangements. Researches emerging trends, evaluates opportunities, and provides recommendations for participation in health plan programs and insurance products. Advocates on behalf of business units for preferred financial terms, operational processes, and promotes administrative simplification with health plans. Promotes consumer friendly pricing strategies achievable within health plan payment methodology logic.

  • Review and analysis of new and renewing contracts, including contract modeling.

  • Proactively track and report all contracting efforts and the strategy at large. Conduct regular status updates with core team and provide management with a clear sense of progress and understanding of any marketplace changes (major insurance, network and reimbursement issues, changes in legislation or in guidelines at the federal levels) during the course of the performance year.

  • Provide support and representation with executive audiences, across all team segments, as needed. Assist the executive team in developing contacts and relationships for the payer markets in newly targeted regions as needed. Work closely with the Business Development team to build and work with relationships already established.

Required/Preferred Education/Experience/Specialized Skills/Certification: 

  • Bachelor’s degree in business administration, economics, finance, clinical science, or other related field required

  • Master’s degree in health administration, business administration, economics, finance, or other related field preferred

  • Five (5) years of management experience in medical group fee-for-service, shared risk and global risk HMO, PPO and ancillary services negotiations and contracting experience, including strong knowledge of legal and financial issues.

  • Strong financial modeling and analytic skills and experience overseeing this function in the a multi-state group setting.