WellSpan Health

Payor Contract Negotiator Senior

WellSpan Health • $75K — $95K *
York, PA 17403In-Person
Healthcare
Less than 5 years of experience
3 days ago
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Job Overview by Ladders

Qualifications

  • Bachelor's Degree in Finance, Accounting, Management, or Health Care Administration required
  • Master's Degree in Management, Healthcare Administration, Finance, or Payor Relationships preferred
  • 3 years of experience in Health System Revenue Cycle operations and payment methodologies required
  • 5 years of experience in healthcare reimbursement and third-party payor negotiation preferred
  • Proficient in Finance, Data Analysis, and Contract Negotiation

Responsibilities

  • Support collaborative relationships with payors and team members
  • Manage contract negotiations for fair payment terms across various payor types
  • Oversee assigned book of business, including commercial and Medicare/Medicaid contracts
  • Analyze financial impacts of contract terms and negotiate updates as needed
  • Ensure accuracy and compliance of contract language with organizational capabilities
  • Participate in strategic improvements and integration within the Contract Integration Team
  • Maintain knowledge of industry trends and regulatory changes impacting payors

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

Manages large third-party payor contract negotiations (such as Medicaid) to ensure fair/adequate payment rates and methodology, and acceptable and manageable operational terms as well as, memorializing such terms into the written payor agreement. Assures payor compliance with contract financial terms. Works independently and exercises independent judgment and discretion. Works collaboratively with strategic WellSpan Health Payors.

Responsibilities

Duties and Responsibilities

Essential Functions:
  • Supports professional and collaborative relationships with Payors and team members.
  • Manages active contract negotiation processes to ensure System contracting terms are adequately addressed, and the administrative process is controlled effectively on behalf of the Health System.
  • Manages assigned payor book of business including, but not limited to, Commercial, Medicare Advantage, Medicaid for both PA and MD based providers.
  • In conjunction with Business Manager and operational staff, analyzes financial impact of contract reimbursement, policy, or language changes/initiatives. Negotiates with payors to resolve via rate or language updates.
  • In conjunction with Director of Payor Contracting, assures that proposed, new and/or changed contractual programs are attainable within the organization, the contract language accurately memorializes the agreed upon terms and appropriate WellSpan Health personnel is educated on the new or changed programs.
  • Maintains knowledge of industry accepted contractual arrangements, financial opportunities, operational challenges, and other payor initiatives, including but not limited to State and Federal MCO regulatory programs.
  • Participates in the strategic improvement of payor contracts as part of the Contract Integration Team and at times with Chief Clinical Directors, Directors of Quality, Administrative Vice Presidents, Quality and Clinical Improvement Managers, Ancillary and Hospital Leadership and Payors.
  • Monitors and maintains knowledge regarding market activities and changes related to health insurance plans, programs, and regulations.
  • Researches and reports on specific requests, as assigned.
  • Participates in annual education, committees, and educational offerings.
  • Participates, and in some cases, manages WellSpan Health's third-party facility, ancillary, behavioral health, hospice, and dental payor contract negotiations to ensure fair/adequate payment rates & methodology, and acceptable and manageable operational terms as well as, memorializing such terms into the written payor agreement.
  • Works independently and exercises independent judgment and discretion.

Common Expectations:
  • Continuously assesses Payor performance. Maintains appropriate quality control/assessment programs (if applicable).
  • Enhances professional growth and development through participation in educational programs, current literature in-service meetings, and workshops.
  • Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation. Works well in teams.
  • Participates in and continuously assesses and improves the department/service line/entity/System's performance.
  • Presents strong negotiation and presentation skills.

Travel Requirements:
  • Estimated Amount: 10% - Local and regional travel


Qualifications

Qualifications

Minimum Education:
  • Bachelors Degree Finance, Accounting, Management and/or Health Care Administration Required
  • Masters Degree Management, HealthCare Administration, Finance, Payor Relationships Preferred

Work Experience:
  • 3 years Working knowledge of Health System Revenue Cycle operations and payment methodologies and overall understanding of various aspects of health care financing. Required
  • 5 years Healthcare reimbursement, third party payor negotiation/operations or regulatory experience Preferred

Courses and Training:
  • Finance, Data Analysis, Contract Negotiation Upon Hire Required

Knowledge, Skills, and Abilities:
  • Excellent written and oral communication skills.
  • Interpersonal and computer skills.
  • Analytical, negotiation, and project management skills.
  • Able to work well in a team.

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

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