The Director of Payor Contracting is responsible for all stages of payor contracting with the primary goal to maximize net revenue and ensure compliance through commercial contracting, contract payment, recovery analysis and analysis of government payer performance. This position will involve developing and implementing strategic relationships with major payors on a national level as well as negotiating contracts.
ESSENTIAL DUTIES AND RESPONSIBILITES:
Defines and establishes overall Sound Physicians’ strategy regarding agreements with commercial payors.
Directs and manages contract negotiations with carriers and maintains these payor relationships.
Assures timely updates, renegotiation and revision of commercial payer agreements.
Analyses contracts and prepares recommendations for agreement participation and non-participation.
Creates and assures financial analysis and monitoring, as well as collection of appropriate payments for all agreements.
Incorporates legal language within payor contracts that is consistent with Sound Physicians’ legal policy..
Works closely with internal colleagues to improve contract reimbursement and timely payments.
Manages critical external communications, including documentation, certification and file management related to commercial payer relationships.
Develops and implements consistent organization wide pricing policies.
Performs other related duties and special projects as assigned
SPECIAL KNOWLEDGE, SKILLS, ABILITIES, TRAINING, OR SPECIAL LICENSES/CERTIFICATIONS NEEDED TO PERFORM YOUR JOB:
Excellent organizational abilities
Excellent written and oral communication skills
Strong presentation skills
Strong negotiation skills
Attention to detail and accuracy
Client service oriented (both internal and external)
Creative and persistent problem solver
Able to handle confidential material in a reliable manner
Ability to interact and communicate with individuals at all levels of organization
Strong interpersonal skills to handle sensitive situations and confidential information
Ability to multi-task and prioritize workload in a fast-paced environment
Proficiency with Microsoft Office Suite
EDUCATION / EXPERIENCE:
Required: Bachelor's degree or equivalent experience
Required: 7-10 years’ of experience with payor contract management and reimbursement in the physician, hospital and/or payer setting. Experience in developing and implementing strategic pricing programs and prior management experience is required.
LIST SPECIAL JOB OR ENVIRONMENTAL CONDITIONS:
Indoor office environment
Travel required: 2-10 trips per year
This job description reflects the present requirements of the position. As duties and responsibilities change and develop, the job description will be reviewed and subject to amendment.
Our vision is to be the unmatched leader in improving quality and reducing the cost of healthcare for patients in the communities we serve. We measurably improve quality, satisfaction and financial performance of healthcare delivery through exceptional inpatient care, deep investments in our people and performance management expertise, as well as complete alignment with our partners.