WellSpan Health

Manager-Payor Contracting

WellSpan Health • $85K — $100K *
York, PA 17403In-Person
Healthcare
Less than 5 years of experience
Today
Be an Early Applicant
Job Overview by Ladders

Qualifications

  • Bachelor's degree in Healthcare, Business, or a related field
  • 3+ years of experience in payor or provider contracting, and government regulations
  • Supervisory experience required
  • Strong interpersonal skills for effective communication with payors and staff
  • Proficient in written communication and computer skills

Responsibilities

  • Coordinate payor relationship management and team oversight
  • Identify and resolve operational and compliance issues through cross-departmental collaboration
  • Oversee governance of revenue processes to enhance reimbursement and compliance
  • Manage integration of contract changes in clinical departments
  • Lead communication of payor policy changes across the organization
  • Support contract-related issues alongside Payor Contracting Analysts
  • Assist in performance measure data collection for value-based contracts

Benefits

  • Comprehensive health benefits
  • Retirement savings plan
  • Paid time off (PTO)
  • Education assistance
  • Financial education and support, including DailyPay
  • Expanded Paid Parental Leave
Full Job Description
Job Description

General Summary

Is responsible for oversight of the Payor Contract Analyst (PCA) Team; coordinating and facilitating the maintenance and management of payor relationships on behalf of WellSpan Health, as well as the operational management of the Wellspan System contracts. This includes being a resource in the support of the Payor Contract Analysts and other functional areas that deal directly with payors. Facilitates planning and decision making and is responsible, within defined scope, for the day-to-day operation of the PCA team. Participates in a variety of financial projects including attending interdepartmental meetings to address financial trends associated with payor noncompliance.

Responsibilities

Duties and Responsibilities

Essential Functions:
  • Coordinates and facilitates the maintenance and management of payor relationships on behalf of WellSpan Health by serving as a facilitator to provide management support. Acts as resource for payor contracting personnel. Participates and coordinates learning events and training. Participates in the development and maintenance policies relating to operations of departments. Completes the staff's performance evaluations. Provides support of existing payor relationships on all contracts including handling of all operating issues.
  • Identifies operational/denial root causes and processes and works collaboratively with other departments to improve processes when control, operational weaknesses and/or compliance issues are found. Leads improvement initiatives utilizing Lean principles to improve operational and/or financial efficiency of System entities.
  • Provides oversight and governance Payor Research Information Request process and the investigation of revenue processes, including billing system errors, to ensure systems are optimizing reimbursement while maintaining compliance with applicable rules and policies.
  • Participates in the management of payor relationships, integrating contract changes into appropriate clinical areas and managing payor issues with periodic payor meetings. Attends, either in person or virtually, JOC meetings between Payors and the System.
  • Leads the PCA team as they coordinate all System payor policy changes through communication with all applicable departments.
  • Works with Payor Contracting Analysts to maintain payment terms and conditions of Commercial and Government contracts and supports Payor Contracting Analysts in addressing contract-related issues on behalf of internal departments.
  • Assists the Director in the collection and maintenance of performance measure information relative to value-based contract payment terms and voluntary pay for performance programs.
  • Manages contractual notification requirements as defined by contract language for new service additions to the WellSpan Health delivery system.
  • Responsible for facility credentialing/re-credentialing for Summit Health for Commercial, Medicare Advantage Products and PA Medicaid MCOs.
  • Participates in interdepartmental meetings to coordinate improvement in the hospital's revenue cycle.
  • Assists the Senior Director of Payor Contracting and VP of Payor Contracting and in financial analysis and/or other requested projects.

Common Expectations:
  • Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest trends in field of expertise.
  • Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.


Qualifications

Qualifications

Minimum Education:
  • Bachelors Degree In HealthCare, Business or other related field Required

Work Experience:
  • 3 years payor or provider contracting, Accounting, Patient Accounting, Government Regulations, Required and
  • Supervisory experience Required

Knowledge, Skills, and Abilities:
  • Able to communicate and work effectively with payors in finding negotiable solutions out of presented problems;
  • Able to communicate and work well with staff and other departments implementing change and the exchange of feedback across the organization;
  • Excellent written and oral communications and interpersonal skills; computer skills.

Benefits Offered:
  • Comprehensive health benefits
  • Retirement savings plan
  • Paid time off (PTO)
  • Education assistance
  • Financial education and support, including DailyPay
  • Expanded Paid Parental Leave

For additional details: Benefits & Incentives | WellSpan Careers (joinwellspan.org)

About WellSpan Health

WellSpan Health is a non-profit healthcare system that provides services to patients in central Pennsylvania and northern Maryland. The system includes eight hospitals, over 19,000 employees, and more than 200 patient care locations. WellSpan Health offers a range of services, including primary care, specialty care, and hospital-based care. The system is committed to providing high-quality, affordable healthcare to the communities it serves. WellSpan Health was founded in 1998 through the merger of several local healthcare organizations.
Learn more about WellSpan Health
Size
20,000 employees
Industry
Healthcare
* Ladders Estimates

Similar Jobs

Ad banner background

Get Ready For Your
Next Interview

More Jobs at WellSpan Health

More Healthcare Jobs

Find similar Manager-Payor Contracting jobs:

NationwideYork, PA