Physician and Provider Contracting Director
5 - 7 years experience • Managed Care & Health Insurance
Reporting to the Assistant General Counsel and indirect reporting to the Chief Operating Officer, the Director of Physician and Provider Contracting is responsible for the oversight and management of the system, processes and standards for physician and allied health provider contracting, assuring associated regulatory compliance, organizational integrity and business objectives are met. Accountable for all activities associated with medical staff contracting and associated regulatory and quality standards. Assures Fair Market Value compliance, and quickly remedies outliers or concerns. Position is responsible for providing data analysis and reporting, trends and issues and supporting documentation to support the review, approval and decision-making process for physician and provider contracting, including physician compensation models and oversight of all physician contract arrangements, including call and coverage contracts, medical director agreements, and facultycontracts through the school of medicine. Knowledge of legal and contractual arrangements, standards, regulatory requirement and standards and experience in contracting with individual physicians and groups. Assures a strong contracting system is in place to meet standards and timeliness of all new and ongoing contracts. Works collaboratively with the community physician and administrative leaders and legal to resolve key issues and meet requirements. Collaborates with the Chief Medical Officers to execute the physician integration plan. Serves as a project manager for implementing integration efforts with other physician groups. Exercises sound judgment in developing and implementing systems, processes and work flow methods. Is a trusted advisor and subject matter expert in areas of responsibility.
1. Leads the negotiation, in collaboration with other identified leaders for contracting arrangements. Responsible for oversight, analysis, and reports necessary for final review and approval and implementation of physician/provider contract agreements. Facilitates the approval process of all contract documents from pre-contract through post-signature phases.
2. Works in conjunction with key leadership and legal counsel to develop new physician contracttemplates and agreements. Routinely reviews and revises existing agreements that support the clinical, programmatic, and financial goals of the organization.
3. Develops, implements, and evaluates physician compensation strategies and models which align with financial and organization objectives, clinical and operational standards, and fair market value.
Ensures monthly payments are made to contract physicians and monthly time logs are received, completed and comply with established duties outlined in physician contract.
4. Performs financial modeling, conducts internal valuations and assessments, and/or obtains external valuations for each agreement to ensure compliance with policies and regulatory requirements. Identifies areas to improve provider service levels within budget parameters. Heavy emphasis on analyzing cost and utilization data to develop specific actions to manage cost.
5. In conjunction with the Project Management Office (PMO), collaborates with the Chief Medical Officers to execute the physician integration plan. Serves as a lead project manager for implementing integration efforts with faculty and other physician groups.
6. Coordinates with operations and revenue cycle staff to ensure alignment between physician contracted work, actual work done, and billing.
7. Responsible for the accuracy of supporting documentation for contracts and completing documents required by Legal and Compliance. Develops and implements a system to track contract expirations, necessary renewals, and any requirements and notices must be provided.
8. Maintains current knowledge of legal and regulatory requirements related to physician contracts. Ensure compliance with legal department requirements.
9. Administers and maintains the electronic contract management database, including maintaining the database of all existing agreements and assuring communication of all changes with financial and/or budgetary impact.
10. Develops and maintains processes that provide timely notification of critical customer contractevents (i.e. renewals, termination and due dates contained within the agreements).
11. Performs other duties as assigned.
QUALIFICATIONS Required unless otherwise stated
EDUCATION: Bachelor’s degreerequired.
? Master’s degree in Public Health, Healthcare Economics, MBA, and/or related field preferred.
Minimum of 5years of healthcare management experiencerequired, relevant to the position.
? Experience with hospital, clinic, physician, and performance-based primary care and health system contracting required.
? Experience with contract management tools, templates, methods and processes.
? Experience working in a managed care and/or government health program preferred.
Ability to develop and maintain excellent working relationships with hospital leadership and physicians.
? Prior experience in physician and provider contracting, including negotiations, compliance, compensation models, and operational and clinical standards and systems
? Superb communications skills in formulating and communicating accurate and precise data process, findings, and recommendations via executive level reports and presentations.
? Exceptional ability to manage and prioritize projects in a cross-functional matrix environment; strong project management skills; demonstrated self-motivation, creativity, problem-solving and critical thinking skills.
? Financial acumen, and strong analytical skills to understand the implications of contractual arrangements and parameters.
? Excellent interpersonal, written and verbal communication skills.
? Demonstrated ability to complete projects in a fast-paced environment with competing and sometimes conflicting priorities.
? Serve as subject matter expert on physician contracting and physician compensation methodologies.
? Advanced analytical and modeling skills, problem-solving, interpretation, budgeting and reporting skills
? Proficient in Microsoft Office suite of applications, advanced Excel skills.
Security Clearance Required: No
Visa Candidate Considered: No
Base Salary - $98,000 to $120,000
Full-time Benefits - Full
Relocation Assistance Available - Possible for ideal candidate
Commission Compensation - No
Bonus Eligible - No
Overtime Eligible - No
Interview Travel Reimbursed - Yes
5+ to 7 years experience
Seniority Level -
Management ExperienceRequired - Yes
Minimum Education - Bachelor's Degree
Willingness to Travel - Occasionally