Director Payer Relations and Contracting

Carle Health • $118K — $203K *
US-AnywhereRemote in Champaign, IL
Healthcare
8 - 10 years of experience
Today
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Job Overview by Ladders

Qualifications

  • Bachelor's Degree in a related field such as Economics or Finance, or equivalent experience.
  • Minimum of 10 years in a related field.
  • Strong interpersonal and negotiation skills for managing third-party payer relationships.
  • Proficient in analytical and problem-solving skills.
  • Demonstrated leadership abilities with a focus on team development.

Responsibilities

  • Negotiate contracts and manage the payer portfolio including various agreements.
  • Perform contract analytics to model reimbursement impacts and fee schedules.
  • Create and implement procedures for identifying expiring contracts that require renegotiation.
  • Establish a written strategy for contract negotiation procedures.
  • Communicate Carle's billing and pricing policies to payers clearly.
  • Administer day-to-day contract management including amendments and renewals.
  • Facilitate communication on contract changes across departments within Carle.

Benefits

  • Comprehensive benefits package including healthcare.
  • Opportunities for professional development and leadership training.
  • Collaborative work environment with multidisciplinary teams.
Full Job Description
Overview
The Director Payer Relations and Contracting will lead staff and processes for payer (commercial and government) relationships and contracting, including partnering with the Vice President to negotiate contracts and manage the payer portfolio, oversee and perform contract analytics, maintain currency on payer/provider benchmarking and best practices and payment policies/programs, and reviews and routes for approval Single Case Agreements. Responsibilities
  • Partners with Vice President to negotiate contracts and manage payer portfolio including commercial contracts, Medicare Advantage agreements, Medicaid managed care, employer direct contracts.
  • Contract analytics - model reimbursement impacts, fee schedules, escalators, utilization assumptions.
  • Develop, maintain, and administer specific written procedures to identify expiring contracts that need to be renegotiated.
  • Develop, maintain, and administer specific written strategy for contract negotiation procedures.
  • Understands Carle billing and pricing policies and can communicate those policies to payers and understands how Carle policies align or are in conflict with payer policies.
  • Responsible for day-to-day contract administration, amendments, and renewals.
  • Responsible for communicating throughout Carle any changes and updates on payer contracts and for ensuring that impacted administrative and clinical departments have had input on new contracts and changes to existing contracts.
  • Provides primary support for payer relationships.
  • Develops and cultivates relationships with staff from Patient Financial Services, Revenue Cycle Systems, and Patient Access to facilitate communications regarding payer opportunities and issues.
  • Manages payer/provider industry benchmarking and best practices and stays current on commercial and governmental payer policies and programs.
  • Reviews and approves (or routes for approval) Single Case Agreements in accordance with established contract standards.
Qualifications

Certifications:

  • N/A

Education:

  • Bachelor's Degree: Related Field or
  • Bachelor's Degree: Economics or
  • Bachelor's Degree: Finance or
  • Experience In Lieu of Education

Work Experience:

  • Related field - 10 years

Specialized Skill & Knowledge

  • Requires strong interpersonal and negotiation skills for 3rd party payer negotiating and relationships.
  • Strong analytical, problem-solving and leadership skills.
  • Demonstrated ability to develop and manage team members effectively as well as other areas within Carle that are impacted by payer contracts.
  • Demonstrated ability to work independently and as part of a collaborative team.
Salary RangeThe compensation range for this position is $56.86per hour - $97.8per hour. This represents a good faith minimum and maximum range for the role at the time of posting by Carle Health. The actual compensation offered a candidate will be dependent on a variety of factors including, but not limited to, the candidate27s experience, qualifications, location, training, licenses, shifts worked and compensation model. Carle Health offers a comprehensive benefits package for team members and providers. To learn more visit careers.carlehealth.org/benefits.

About Carle Health

Carle Health Careers

Joining Carle Health represents a unique opportunity to be part of a team that is committed to innovation, leadership, and professional growth. Carle Health is renowned for its dynamic culture, diversity, and dedication to the development of its team members.

Explore Job Opportunities

Carle Health offers a variety of job opportunities that cater to a range of skills and professional interests. Whether one is just starting their career or looking to make a significant change, Carle Health provides a platform for professional development and personal growth.

Internship Programs

For those beginning their professional journey, Carle Health's internship programs offer invaluable industry experience and networking opportunities. Interns at Carle Health gain hands-on experience, working alongside seasoned professionals and learning about the healthcare industry from the inside.

Employment Benefits

Choosing a position at Carle Health means more than just a job; it's a commitment to personal and professional development. The company offers competitive benefits designed to support the health, well-being, and financial security of its team members and their families.

Inclusive Company Culture

Carle Health is dedicated to fostering an inclusive environment where diversity is celebrated, and every team member feels valued. Diversity training and leadership development are integral parts of the culture at Carle Health, ensuring that all team members have the opportunity to thrive.

Career Growth and Development

Carle Health is committed to the growth of its team members. With a variety of resources for career advancement, including professional development courses, leadership training, and more, team members are equipped to excel in their roles and beyond.

Hiring Process

The hiring process at Carle Health is designed to be transparent and engaging. Candidates can expect a thorough interview process where they can showcase their skills and learn more about the company's values and opportunities. Tips for crafting an effective resume and succeeding in interviews can be found on Carle Health's Careers Blog.

Networking and Innovation

At Carle Health, innovation is at the core of everything they do. Team members are encouraged to engage in networking events that foster creative solutions and drive industry-leading practices.

Join the Carle Health Team

Explore open positions that match your skills and interests. Carle Health is looking for passionate, curious, and solution-driven team players. Search Carle Health Jobs today and find out what exciting and rewarding opportunities await.

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Industry
Hospitals & Medical Centers
* Ladders Estimates

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