Director, Payor Relations

Location:

Calmont Operations Building

Department:

Payor Relations

Shift:

First Shift (United States of America)

Standard Weekly Hours:

40

Summary:

The Director of Payor Relations is responsible for developing and maintaining meaningful and effective relationships with managed care organizations and internal staff with the goal of securing, managing, and renegotiating viable, revenue generating health care service contracts on behalf of CCHCS entities and providers with both commercial and government funded managed care organizations.

The Director will manage payor intelligence, contract implementation and validation as well as oversee issues and follow up on contract related claims issues.

Qualifications:

• Bachelor's degree preferred.
• At least ten (10) years of operational experience in a manage care setting required.
• Extensive experience in contract negotiation and payor relations required.
• Superior knowledge of medical terminology.
• Must be able to foster and maintain healthy relationships with outside payors. Must have a clear understanding of the intricacies of commercial, state and federal government funded insurances.
• Must be detail oriented with a high level of verbal and written communication skills.
• Must have high level of problem solving and presentation skills.
• Must be able to work independently, effectively supervise staff and actively participate as an integrated team member.

About Us:

Cook Children's Health Care System

Cook Children's Health Care System offers a unique approach to caring for children because we are one of the country's leading integrated pediatric health care delivery organizations. Patients benefit from the integrated system because it allows Cook Children's to use all of its resources to treat a patient and allows for easy communication between the various companies by physicians with a focus on caring for children and adolescents.