Director - Managed Care Payor Contracting

Primary City/State:

HonorHealth - 8125 N Hayden Rd Scottsdale, AZ 85258 Category:

Contract Management Shift:

Day Department:

Payor Contracting

 Hours: Monday-Friday Days

Location: Remote -- Must be located in Arizona -- Will come on site 1-2 times per month.


 Great care starts with great people. (Like you.)

At HonorHealth, you’ll find something special. From humble beginnings in 1927 to one of Arizona’s largest nonprofit healthcare systems, our culture is built on warmth and neighborly kindness. Behind every smile is a highly skilled professional with deep expertise and an unwavering dedication to what matters most — caring for the health and well-being of people and communities across the greater Phoenix area.

Responsibilities:

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 JOB SUMMARY
• The DIRECTOR PAYOR CONTRACTING, develops with senior management, the Contracting payor strategies for the organization , including but not limited to: payors (health plans, government entities, employers) for Network facilities, employed physicians, bundled payment, joint ventures, ambulatory care, Federally Qualified Health Centers (FQHC), and clinically integrated network(s). Manages and directs the Network contracting process, including pricing, negotiation, and profitability. Works closely with Enterprise Analytics, Physician Billing and Finance in the requirements, development and analysis of contracting information utilizing key systems and related reports. Provides Network data and analysis to determine Network direction related to payer and employed physician profitability. Interfaces with clinical and administrative staff to operationalize Network contracts to minimize lost revenue and decrease costs. Builds strong relationships externally and internally with payers, employed physician leadership, management, employees and any organizations with whom Network contracts or is a joint venture partner. Provides Network leadership in Contracting organizational change as well as industry changes that impact the system. Works closely with, and acts as a consultant to the employed medical group and Physician Billing for employed physician contracting, reimbursement strategies, payer relationships, physician utilization and profitability. Key liaison for Inpatient Care Management, Clinical Denials and Revenue Cycle department(s) with payers and payer related issues, particularly related to contract requirements. Key member of the Network's Reimbursement Team which oversees revenue management and strategy related to contracting. Plays key role in analyzing accounts receivable and accelerating cash flow through contracting. Plays advocacy role for Network related to payor, employed physician and integrated network (ACO) payor contracting strategies.
• ESSENTIAL FUNCTIONS
• Proposes, recommends and develops with senior management, the payor contracting strategies for the Network, which may include health plan payors, government entities and direct contracting with employers, involving Network facilities, employed physicians, home health, joint ventures, ambulatory care, FQHC(s), clinically integrated network (ACO’s) and others, in the form of fee for service, bundled payment, or forms of risk sharing, etc. Analyzes payor and employed physician contracts for utilization, operational trends, and profitability. Presents data to senior management Network leaders to serve as a basis for key decision making, corporate direction and strategy, opportunities to maximize operation efficiencies and new business initiatives, all of which have a major financial impact on the organization. Leads the Reimbursement Team, which sets the Network payor strategy and oversees reimbursement negotiations and trends.
• Directs and manages the contract negotiation process and builds payor relationships to maximize revenue for the Network. Interacts and negotiates with payors’ senior and executive management. Develops and implements contracting policies and procedures to optimize patient flow, pricing, while decreasing payor denials.
• Directs the marketing of existing and new health services to the payor community to increase patient volume and reimbursement. Works with key medical leaders and service line directors to educate payers on key service offerings and establish rate structures that balance profitability and transparency. Provides input for proper balance of revenue generation, cost control and quality.
• Recommends and oversees information systems to manage expected payor reimbursement and related activities (e.g. denials, etc.) and provides information on contract and business performance. Provides Network access to contract language and payer information online through on-going database development and management, including consistent interpretation of rates and payment methodologies to the Revenue Cycle department(s) and Physician Billing.
• Develops, implements and directs projects to integrate successful payor contracting strategies throughout the Network. Organizes and leads intra-departmental efforts with executive, service lines and management staff to embrace contracting initiatives that will serve to position the Network advantageously in the market and to expand the Network market share.
• Acts as a consultant to the employed medical group and Physician Billing related to payer relationships in the contracting and reimbursement process for employed physicians. Provides leadership and consultation to decrease administrative costs related to physician reimbursement and maximize payor payment, in alignment with Physician Billing.
• Works collaboratively with the Revenue Cycle department(s), to accelerate cash flow and increase timely and accurate reimbursement with payors. Works with external organizations, as well as internal government relations, to respond to legislation, provide data and analyze reports.
• Works closely with Enterprise Analytics and Physician Billing to develop and maintain electronic Network payer and employed physician utilization and revenue information to accurately forecast and trend contract revenue. Provides consultation to Finance in the annual revenue budget development related to payers. Plays integral role with Finance in the ongoing and annual charge master review.
• Develops internal management staff knowledge of payor contracting issues through networking and training. Liaison to and consultant with Care Coordination/Case Management, Clinical Denials, and Clinical Documentation Improvement related to payers, incorporating related utilization management information into payor contracts. Develops individual Letters of Agreement for specific patients as required.
• Supervises and develops a contracting team environment that fosters cross training with Network Development. Provides direction in the planning, establishing, and revising of work assignments. Interviews, selects, and recommends hiring of personnel. Oversees the recommendations for changes in classification, salary action, promotion, demotion, transfer and termination. May settle employee problems and administer appropriate disciplinary action.
• EDUCATION
• Bachelors in Business Administration, Health Administration, Finance or Health related field Required
• Masters in Business or Health Administration Preferred
• EXPERIENCE
• 5 years hospital or health plan and physician contracting; contract analysis; negotiation of contracts Required
• Other Demonstrated management experience in contract negotiation and business development in a health plan and hospital setting which has included physician contracting. Hospital operations experience an asset. Knowledge of government payer programs an asset. Clinical background an asset. Preferred
• LICENSE AND CERTIFICATIONS
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