The Director, Managed Care – Arbitrations position will be responsible for execution of the overall managed care payor dispute resolution strategy and processes within Envision’s physician service lines. This will include support in development of both state and national strategies, analyzing market data to inform and support those strategies, and conducting negotiations in settlement and arbitration processes.
The position will report directly to Envision’s VP, Managed Care and work extensively with the regional contract negotiation teams responsible for managing the geographic portfolios across all professional service lines. Additionally, the position will collaborate across a matrixed team of revenue cycle, legal, and administrative resources and possess executive level visibility.
- Analyze reimbursement trends and commercial claim fair market value benchmarks across multiple geographies for all professional service lines
- Deploy superior analytical skills in the development and use of focused market datasets to assist in dispute resolution proceedings
- Engage and serve as external facing negotiation lead during informal settlement conferences and arbitration proceedings related to reimbursement for commercial payor claims
- Develop and maintain a deep understanding of state and federal legislation related to payment initiatives and policy changes
- Foster strong inter-company relationships that facilitate cross functional monitoring of payor issues
- Assist in the development of departmental goals, execute projects to achieve these goals, and work closely with others in the department to continuously monitor department performance
- Demonstrate leadership and/or people management skills
- Travel overnight and locally as needed
- Regular and reliable attendance
- Other duties as assigned
- Responsible for adhering to Information Security Policies and ensuring Envision is as secure as possible.
To perform this job successfully, an individual must be able to perform each essential responsibility satisfactorily. The requirements listed below are representative of the knowledge, skills and/or abilities required.
- Possess a strong understanding of the healthcare industry and payor-provider reimbursement methodologies as well as pricing strategies
- Skilled negotiator with a proven track record and able to achieve results in challenging environments, including direct experience within contract and dispute resolution negotiations
- Experience with using, managing, and interpreting large amounts of healthcare data
- Attention to detail and willingness to independently and collaboratively analyze market conditions in order to execute complex and data-driven negotiations
- Ability to deliver time-pressured projects on time and with the desired results through a structured project management (time, team, work-stream management) approach
- Excellent written and oral communication skills, confident and impactful presenter
- Ability to work in a matrix environment and manage a large number of matters simultaneously
- Willingness to assume responsibility for communication and execution of corporate initiatives
- Self-directed with a strong bias for action
- Excellent customer relationship / management skills
- Bachelor’s degree required
- Five (5) years relevant experience including supervision, managed care contracting, financial analysis, payment methodologies, contract language and negotiations
- Equivalent experience considered