The Senior Director for Payor Relations will be responsible for:
Synthesizing information related to out-of-state public payors across service/business lines, identifying and tracking major trends and developments in publicly-financed pediatric care that affect delivery of pediatric care in national markets in collaboration with Finance/Contracting, Patient Services, and Information Technology.
Promoting inpatient, outpatient, and ambulatory services of the Hospital and its physicians through outreach, education and network development efforts aimed at government payors and Medicaid managed care entities.
Overseeing lobbyists and consultants supporting out-of-state Medicaid negotiations, contracting and dispute resolution processes.
Coordinating and enhancing enterprise relationships with in-state and out-of-state payors, with an emphasis on government/public payors.
Leading efforts to assure that out-of-state patients continue to have access to Boston Children's and its specialists at fair rates of reimbursement.
Supporting the enterprise in evaluating and responding to legislative and regulatory policies impacting the contracting environment.
Interpreting and drafting regulatory and policy-related materials, including those involving payor and provider payment and performance methodologies and standards.
Developing and maintaining relationships with internal and external constituencies.
Supporting the implementation of patient engagement and provider continuing education strategies relating to providing access and assuring fair reimbursement for out-of-state patients and families, especially those with medically complex conditions.
To qualify, you must have:
Master's Degree in Business Administration or a related/equivalent post-graduate degree.
10 years of progressively responsible experience in the development, evaluation and execution of strategic initiatives for a complex health care organization or healthcare-related field.
7 years of business/health care analytics experience.
Experience with contract development and evaluation.
Experience in state budget processes and procurements preferred.
Superior interpersonal and leadership skills.
Strong financial acumen including the ability to provide sound analysis and the ability to understand and anticipate the impacts of the changing health care market environment.
Certification, Registration, or Licensure Required
All necessary state and federal lobbying registration and compliance with applicable state and federal rules.
This role is within the Office of Government Relations and reports to the Vice President of Government Relations. The Boston Children's Hospital's Office of Government Relations works with policy decision-makers at the local, state, and national levels to uphold the hospital's mission of providing exceptional clinical care, research, and training for pediatric providers. We have a special interest in, and commitment to, our community health programs. We work to develop sustainable and systemic solutions to child health concerns, such as asthma, obesity, child development and mental health. We closely monitor issues related to public and private sector coverage, access to care and the health care regulatory environment. We also pay close attention to research and pediatric workforce concerns. We are proud of our many partnerships and collaborations with community organizations that advocate on behalf of children.
Boston Children's Hospital is an Equal Opportunity / Affirmative Action Employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, national origin, sex, sexual orientation, gender identity, protected veteran status or disability.
Internal Number: 2670704
About Boston Children's Hospital
Boston Children's Hospital is a 395-bed comprehensive center for pediatric health care. As one of the largest pediatric medical centers in the United States, Children's offers a complete range of health care services for children from birth through 21 years of age.