Department:Status:Benefits Eligible:Yes
Hours Per Week:40
Schedule Details/Additional Information:Pay Range$86.75 - $138.80
Major Responsibilities:- Develops and manages a portfolio of payer contracts that optimize enterprise organization revenue, margin and growth in alignment with mission and strategic objectives.
- Establishes and maintains positive, appropriate relationships with market payers. Utilizes communication and organizational skills to work collaboratively and credibly with payers to achieve common objectives and assist in the resolution process related to any disputes.
- Works collaboratively with internal stakeholders across all business units to define and achieve common payer strategy and reimbursement objectives.
- Develops and executes communication plans to internal and external stakeholders related to payer relationships, negotiations, organizational contractual obligations, and developments in the managed care marketplace.
- Works with the Vice President of Revenue Analytics to ensure financial analysis of payer contract performance and modeling projections based on alternate contract agreements with payers, adverse trends, etc., and then makes appropriate recommendations or conclusions for the enterprise.
- Performs high level review and monitors financial aspects of existing managed care contracts. Utilizes the financial analysis of reimbursement rates from Revenue Analytics for feedback on contract renewals, renegotiations or termination. Makes recommendations regarding participation or non-participation with new or existing agreements and provide feedback to entire Aurora senior leadership regarding financial and/or operational issues with payers.
- Works with Legal to ensure consistency and to the extent possible, standardization of contract terms.
- Develops and manages the risk sharing and reconciliation process to manage financial guarantees related to payer and employers.
- Interfaces with government relations related to any conflicting issues regarding Medicaid management with the State.
- Performs human resources responsibilities for staff which include interviewing and selection of new employees, promotions, staff development, performance evaluations, compensation changes, resolution of employee concerns, corrective actions, terminations, and overall employee morale.
- Develops and recommends operating and capital budgets and controls expenditures within approved budget objectives.
- Responsible for understanding and adhering to the organization's Code of Ethical Conduct and for ensuring that personal actions, and the actions of employees supervised, comply with the policies, regulations and laws applicable to the organization's business.
Licensure, Registration, and/or Certification Required:Education Required:- Bachelor's Degree in Business, or
- Bachelor's Degree in Health Care Administration or related field.
Experience Required:- Typically requires 15 years of experience in contractual, administrative, health insurance and operations related to managed care organizations, physician groups, hospitals and health insurance benefit plan designs. Includes 10 years of management experience in the management of staff, budgets, and multiple managed care contracting functions.
Knowledge, Skills & Abilities Required:- Proven and extensive contracting technical skills; contract preparation and implementation, financial analysis and rate proposal development, and in depth knowledge of various reimbursement methodologies.
- Ability to negotiate with excellent interpersonal, diplomatic, and problem solving skills.
- Self motivated, with excellent written and verbal communication and presentation skills.
- Proficiency in the use of Microsoft Office (Excel, Access, PowerPoint and Word) or similar products.
- Ability to assess problems and effectively implement solutions.
- Advanced skill in financial analysis with a track record of achieving financial targets.
- Demonstrated experience in overseeing financial agreements with vendors, legal negotiations and contract finalization.
Physical Requirements and Working Conditions:- Position may require travel which may result in exposure to road and weather hazards.
- Exposed to normal office environment.
- Operates all equipment necessary to perform the job.
This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.
Our Commitment to You:Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more - so you can live fully at and away from work, including:
Compensation- Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
- Premium pay such as shift, on call, and more based on a teammate's job
- Incentive pay for select positions
- Opportunity for annual increases based on performance
Benefits and more- Paid Time Off programs
- Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
- Flexible Spending Accounts for eligible health care and dependent care expenses
- Family benefits such as adoption assistance and paid parental leave
- Defined contribution retirement plans with employer match and other financial wellness programs
- Educational Assistance Program
Note: Eligibility for programs listed above may depend on your FTE or status (e.g., full-time, part-time, per diem, temporary, etc.); please ask a Recruiter for more information during an interview.
