CORE RESPONSIBILITIES:
Contract Negotiations & Support of Overall Strategy
- Negotiate and contract to optimize reimbursement structures and rates with payor partners, including the facilitation of the approval and signature process.
- Negotiate language and terms and conditions across all payor contracts, primarily value-based
- Work directly from guidance of Director of Payor Contracting to support a work plan/strategy
- Work to support system strategic initiatives, as directed by the Director of Payor Contracting
- Develop guidelines for best practice items and key contractual acceptable language to support negotiations with a consistent approach where possible
- Amend existing agreements to find opportunities for coverage of new services or to enhance current contract terms in terms of new language or operational needs
- Leverage internal BI/RCM data to assure negotiated rates and rate requests maintain our competitive position
- Stay informed on market trends and healthcare industry shifts to help inform overall payor strategy and successful negotiations
Outcomes Management & Operational Support
- Recommend necessary strategies to leadership based on contract performance
- Work closely with RCM on operational issues related to Payor Contracting - includes attendance at Payor Ops and Joint Operating Committee (JOC) meetings and support to RCM leadership to help monitor financial performance of assigned payor contracts versus expectations
- Partner with teams directly responsible for validation of payments and/or policy monitoring
- Identify and develop strategies to mitigate risks and sources of exposure in payor contracts
- Proactively work with BI and other data teams to refine the reporting of contract performance, analysis, and modeling tools
- Prepare relevant recommendations and reports for committees and boards, as required
Stakeholder Support & Engagement
- Establish and maintain relationships with payors contacts and help facilitate overall relations
- Provide education on new agreements - via written communication or presentations - that may impact stakeholders.
- Address leadership data needs resulting from new/modified agreements
- Work with other internal partners on supporting/leading select system strategies where Contracting can drive specific change or help develop new processes
- Contribute to communications and education regarding Payor Contracting utilizing tools such as the electronic newsletter, educational sessions, or other appropriate forums as needed
- Interact with providers to identify payor trends requiring action or escalation
- Continue to grow knowledge of market trends via conferences, continuing education, etc.
- Maintains strict confidentiality in alignment with HIPAA (Health Insurance Portability and Accountability) guidelines and InterMed policies.
- Perform other duties to support the mission, vision and values of InterMed.
KNOWLEDGE, SKILLS, AND ABILITIES:
Education:
- Bachelor's degree required. Preferred areas of study include Healthcare Administration, Business, Finance, or another related field.
Experience:
- Minimum 3 years of experience in a similar or related role such as managed care/ACO contracting, provider/payor relations, project management, physician organization, hospital organization or health plan.
- Experience in value-based healthcare strongly preferred
- Demonstrated experience in negotiating and managing complex payor contracts
- Proficiency in Microsoft Office suite
- Strong organizational and time management skills to help prioritize tasks and meet deadlines
- The ability to build strong relationships with internal/external stakeholders
- Strong analytical and problem-solving skills
- The ability to interpret and present operational and financial impacts related to Payor contracts
- Strong interpersonal, communication (written/verbal) and presentation skills
- Awareness of relevant healthcare industry trends
