Manager, Payer Contracting - Hybrid - Must Reside in Colorado

Denver Health • $89K — $137K *

Denver, CO 80219Hybrid

Healthcare

5 - 7 years of experience

Today

Be an Early Applicant

By clicking Apply, I agree with Ladders' Terms of Use and Privacy Policy

Job Overview by Ladders

Qualifications

Bachelor's Degree in Finance, Accounting, Business, Management, or Healthcare Administration required; Master's preferred.
5-7 years of contract management experience with a large managed care system, either as a provider or payer.
Strong understanding of managed care contracts and reimbursement methodologies.
Familiarity with CPT, HCPCS, ICD-10 coding and billing compliance regulations.
Excellent negotiation and financial analysis skills.

Responsibilities

Oversee contract proposals and negotiations with payers and internal stakeholders.
Develop contract standards based on organizational strategy and senior management guidance.
Evaluate and analyze changes in reimbursement methodologies for contract viability.
Ensure proper tracking of contracts within organizational databases for financial performance monitoring.
Negotiate financial agreements with non-contracted entities as necessary.
Resolve complex payer issues and participate in meetings to address contractual payment trends.
Support internal teams with tools and information necessary for effective contract management.

Benefits

Paid time off starting at 28 days per year, including vacation and holidays.
100% paid parental leave up to 6 weeks.
Immediate eligibility for retirement plans with employer contributions up to 9.5%.
Comprehensive medical, dental, and vision coverage plus paid disability and life insurance.
Extensive well-being programs including on-site fitness facilities.
Free public transportation passes through RTD EcoPass.
Childcare discounts and perks on travel and various brands.
Tuition reimbursement and assistance for educational advancement.
Professional development opportunities to support career growth and advancement.
Eligibility for student loan forgiveness programs, including Public Service Loan Forgiveness.

Full Job Description

We are recruiting for a mission-driven Manager, Payer Contracting - Hybrid - Must Reside in Colorado to join our team!

Department
Administration Office

Job Summary

Under the general supervision of the Chief Financial Officer, Director of Payer Contracting, or Associate CFO, the Manager Payer Contracting is responsible for developing and implementing new and established contracts for facility and professional agreements with third party payers on behalf of Denver Health & Hospital Authority, including new programs and services. This role will lead negotiations with assigned payers to include payment terms based on multiple reimbursement models, including fee-for-service payment terms, valued based payments and gain/risk sharing arrangements. The Manager will be accountable for negotiating contract language that aligns with all State and Federal laws/regulations and organizational policies. The position will also be responsible for supervising staff who analyze payor contracts, monitor payor performance to contract and underpayments, monitor changes in payor policies that might impact rates, and ensuring appropriate implementation and maintenance of contracts. This will include working with internal stakeholders on matters related to payor contracting and convening/facilitating workgroups and work sessions to ensure contracts are implemented timely and correctly, and are paying correctly. This will include all payers including commercial, Medicare Advantage, correctional, and some governmental/Medicaid contracts such as Colorado Access, as assigned.

Essential Functions:

At the direction of Executive - Level leader, Oversee organizational payer contract proposals and maintenance, with payors and internal stakeholders. Serve as primary organizational contact during payer contract negotiations on specific contracts where assigned. (20%)
Develop standards for contracts, including payment terms, general language and provisions based on strategy discussions, senior management input and organizational needs. (10%)
Evaluate rate proposals, changes to reimbursement methodologies and conduct related analyses to ensure continued financial viability of the contract. (10%)
Ensures contracts and proposals are properly entered into organizational databases to measure, track and monitor utilization and financial performance of managed care contracts. (10%)
Negotiate single case agreements to capture financial reimbursement from non-contracted entities. (10%)
Ensure correct provider rosters for all commercial payers, including facilitating internal meeting with MSO to ensure that rosters are uploaded timely and any issues with commercial payor rosters are timely resolved. (10%)
Assist HPBS Department and internal customers with resolution of complex payer issues. Participate in JOC meetings with third party payers to address contractual payment issues and trends. (5%)
Communicate and provide tools for contractual terms to other departments whose functions are necessary to the development, implementation and management of the provider arrangements. (5%)
Responsible for the credentialing of Denver Health facilities which includes all associated clinics and new business ventures. (5%)
Provides data analytics and reporting to HPBS Department to identify potential process improvement in charge capture functions to maximize net reimbursement. (5%)
Carry out supervisory responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems. (5%)
Special projects/ other duties as assigned by the assigned supervisor. (5%)

Education:

Bachelor's Degree Concentration in Finance, Accounting, Business, Management, Healthcare Administration related field Required. Master's Degree in a related field preferred.

Work Experience:

5-7 years Contract Management demonstrated experience with large Managed Care systems required with either a provider, a payer, or a mix. Required

Knowledge, Skills and Abilities:

Strong knowledge of Managed Care contracts is required.
Advanced understanding of CPT, HCPCS, ICD-10 and various reimbursement methodologies such as Medicare/ Medicaid and third party billing requirements.
Extensive knowledge and experience with Medicare/ Medicaid regulations.
Excellent negotiating skills and proficiency in utilizing and interpreting financial models and analysis.
Experience with APC reimbursement, CMS rules and regulations, coding and billing compliance.
Strong working knowledge of billing and collection processes and functions, charging processes and general revenue cycle management strategies and industry best practices.
Requires high attention to detail, analytical and critical thinking, management skills, organization, prioritization and problem resolution.
Excellent verbal and written communication, leadership, delegation, collaboration and interpersonal skills
Ability to be resourceful, customer-service oriented and independently problem-solve is required.
Working knowledge of the following information systems to include accessing information, updating, correcting and/ or deleting data. General knowledge related to various software applications and their capabilities. Microsoft Office applications: Word, Excel, Access, PowerPoint and Outlook

Shift

Work Type
Regular

Salary
$89,000.00 - $137,900.00 / yr

Benefits

At Denver Health, we take care of the people who take care of our community. Our benefits are built to support your life, your family, and your future - with generous paid time off, fully paid parental leave, exceptional retirement contributions, comprehensive health coverage, and nationally recognized well-being programs. We invest in your growth through tuition assistance, career advancement pathways, and professional development - while also offering meaningful financial advantages through loan forgiveness eligibility and employer contributions. When you join Denver Health, you're joining a mission-driven organization that invests in you.

Here is a small list of our benefit programs:

Paid time off starting at 28 days per year, inclusive of vacation, personal/sick, and 7 Holidays
100% paid parental leave up to 6 weeks
Immediate eligibility for retirement plans with employer contribution up to 9.5%
Generous medical, dental, vision plans in addition to employer paid disability and life insurance.
Comprehensive well-being programs including on-site employee fitness center located on Denver Health main campus and nationally recognized RESTORE Center
Free RTD EcoPass (public transportation)
Childcare discount programs & exclusive perks on large brands, travel, and more
Tuition reimbursement & assistance
Education, coaching, and professional development opportunities through the Workforce Development Center (WFDC) that support internal career growth and advancement pathways
Professional clinical advancement program & shared governance
Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program
National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer

About Denver Health

Denver Health stands as a beacon of healthcare excellence in Denver, Colorado. Denver’s comprehensive healthcare system offers an array of high-paying jobs and rewarding career opportunities. This integrated network, encompassing a premier hospital, a series of community health centers, and a robust public health department, serves as the city's primary safety net institution. As a Level One Trauma Center with specialized pediatric and neonatal intensive care units, Denver Health is not only pivotal in providing critical care but also plays a significant role in medical education, being affiliated with the University of Colorado School of Medicine.

Overview of Denver Health Careers

A Diverse Range of Healthcare Roles

Denver Health careers span a wide spectrum, from clinical roles in nursing and specialized medicine to administrative and support positions. As a teaching hospital, it offers a unique environment for professional growth, blending patient care with educational opportunities.

Available Job Opportunities

High-Demand Positions

Among the highest paying and most sought-after positions at Denver Health are Psychologist, Psychiatrist, and Licensed Therapist roles. This reflects the system's comprehensive approach to mental health services alongside its medical offerings.

Nursing and Clinical Staff

Opportunities in nursing and other clinical areas offer the chance to work directly with a diverse patient population. And of course, nursing and clinical staff are supported by state-of-the-art facilities and a network of community clinics.

Administrative and Support Roles

From medical billing specialists to healthcare administrators, Denver Health provides a variety of non-clinical positions essential to the smooth operation of the healthcare system.

Qualifications and Requirements

Ensuring the Highest Standards of Care

Denver Health seeks healthcare professionals who possess the necessary skills and experience and are committed to excellence in patient care and continuous learning.

Education and Certification

For clinical positions, specific degrees, certifications, and licenses are required, reflecting the level of expertise and specialization needed to meet the healthcare needs of the Denver community.

Application Process

Steps to Joining Denver Health

The journey to a career at Denver Health begins with a straightforward application process designed to identify candidates who align with the system's values and standards of care.

Submitting Your Application

Candidates can apply through Denver Health's online job portal, where current vacancies are listed. A detailed resume and cover letter tailored to the specific position are crucial components of the application.

Interview Tips and Techniques

Standing Out as a Candidate

Succeeding in the interview requires preparation and an understanding of what Denver Health values in its staff—a dedication to patient care, teamwork, and professional integrity.

Demonstrating Your Fit

Be ready to discuss how your skills, experience, and values align with the mission of Denver Health. Prepare examples from your past work that showcase your ability to contribute positively to the healthcare system.

Training and Development Programs

Commitment to Continuous Professional Growth

Denver Health offers extensive training and development programs, supporting its staff in achieving their highest potential and ensuring the delivery of top-quality care.

Advancing Your Skills

From on-the-job training to formal education programs, employees have opportunities to enhance their clinical skills, leadership abilities, and overall knowledge of healthcare practices.

Benefits and Compensation Packages

Rewarding Your Contribution

Denver Health offers competitive benefits and compensation packages, acknowledging the hard work and dedication of its employees with rewards that reflect their value to the healthcare system.

Comprehensive Benefits

Employees enjoy a range of benefits, including health insurance, retirement plans, and paid time off, alongside opportunities for bonuses and salary advancements based on performance and experience.

Employee Testimonials and Success Stories

From Our Staff to You

Hearing directly from Denver Health employees provides insight into the supportive work environment, career advancement opportunities, and the personal satisfaction derived from making a difference in the lives of patients.

Making an Impact

Employee stories highlight the rewarding nature of work at Denver Health, where every staff member plays a critical role in providing care and improving community health.

Career Advancement Opportunities

Pathways to Professional Development

Denver Health is committed to the career advancement of its employees, offering various pathways for professional development, from leadership roles within the nursing staff to specialized medical positions and administrative leadership.

Contacts and Resources for Further Information

Navigating Your Denver Health Career Path

For more detailed information about careers, the application process, or specific job openings at Denver Health, prospective applicants are encouraged to utilize the following resources:

Denver Health Careers Page

The primary resource for current job listings, application guidelines, and comprehensive information about working at Denver Health.

Further Assistance

For specific questions not addressed on the website, potential applicants can contact Denver Health's HR department directly through the provided contact details on the careers page.

Learn more about Denver Health

Size

7,000 employees

Industry