This position is responsible for supporting the System Contracting department by providing payer contracting subject matter expertise and performing special project as determined by the Vice President of System Contracting and the Director of Managed Care Contracting. Assignments would include providing consultation on, leading and/or performing; complex payer negotiations, financial model development, analytics, and cross-functional system projects and initiatives.
PRINCIPLE DUTIES AND RESPONSIBILITIES:
• Serve as project manager and execute assigned projects. Projects will include complex cross-functional strategic initiatives and payer negotiations.
• Perform analytical functions to evaluate contract performance of fee for service and value-based contract terms to support payer negotiations, collaborating with Payors and system colleagues as needed.
• Serve as subject matter expert on payer contract terms, payer relationships and strategies, fee for service reimbursement terms and value-based financial models. Provide consultation to and educate others within the organization on such subject matter.
• Support strategic initiatives as assigned, including leading or supporting cross functional teams to drive improved performance and evaluate opportunities.
• Effectively coordinate and collaborate with System Contracting and other areas within the organization including Primary Health, Reimbursement, Revenue Cycle, Finance, and Analytics.
• Prepare and present deliverables for executive leaders.
EDUCATION AND EXPERIENCE:
- Bachelors Degree in Accounting, Finance, or a related field required.
- Masters Degree, preferred.
- Minimum 10 years of experience in healthcare industry, required.
- Minimum 7 years of experience in Payer Contracting, with at least 3 years of experience with value based contracting terms, required.
- Expertise of managed care organizations, integrated healthcare systems, and reimbursement methodologies and value-based care financial models required.
- Comprehensive project management abilities.
- Excellent oral and written communication and presentation skills.
- Excellent organizational skills and ability to manage multiple projects simultaneously.
- Excellent interpersonal skills and ability to develop effective working relationship with both internal and external customers.
- Strong negotiation skills. Understanding of legal, business, and insurance operations principles.
- Proficient in Microsoft Word, Excel, and PowerPoint.
