Director, Payor Contracting

Job Description

Job Description

ESSENTIAL FUNCTIONS
· Develop and maintain positive, effective relationships with internal and external customers and serve as the contracting
liaison between contracted Payors and providers.
· Conduct contract analysis and negotiations with Payors on behalf of providers including rates, payment methodologies,
contract language and value- based payment programs in accordance with internal control processes for contract review,
approval and signature.
· Participate in Payor reimbursement analysis that can be routinely updated and maintained as a baseline for strategies to
maximize health plan reimbursement.
· Research and make recommendations to executive leadership in regard to payor contracting opportunities in new and
existing geographic service area.
· Ensure compliance in all business and contractual relationships
· Identify and communicate trends and/or potential issues to management team.
· Other duties and responsibilities as assigned.

EDUCATION
· Bachelor’s Degree in Business, Finance or Healthcare Administration required.

EXPERIENCE
· Proven working knowledge of provider financial issues, complex contracting options, financial/contracting arrangements
and regulatory requirements.
· 5-7 years related experience and comprehensive level of negotiating skills with successful track record negotiating contracts
with payors.
· Strong communication, critical thinking, problem resolution and interpersonal skills.
· Solid understanding of industry dynamics required.

REQUIREMENTS
· Familiarity with managed care products and services, medical cost trend analysis, including analysis of physician contracts,
utilization, and costs.
· Must have prior experience working with managed care contracting modeling.
· Familiar with a variety of concepts, practices, and procedures in the field of managed care.
· Must be able to problem solve and come forward with recommendations.· Must be able to stay on task with minimal supervision.
· Excellent critical thinking, troubleshooting, and analytical skills.

KNOWLEDGE
· Knowledge of payor reimbursement.
· Managed care contracting.
· Market and industry knowledge.

SKILLS
· Strong verbal and written communication skills.
· Strong organizational skills and careful attention to detail.
· Advance computer skills.

ABILITIES
· Ability to analyze problems and interpret information.
· Able and to prioritize and reprioritize, as necessary. Ability to work independently, and as part of a team.
· Ability to multi-task, manages multiple projects, and meets tight deadlines.

ENVIRONMENTAL WORKING CONDITIONS
· Normal office environment.
· Some travel within community.

PHYSICAL/MENTAL DEMANDS
· Requires sitting and standing associated with a normal office environment.
· Some bending and stretching required.
· Manual dexterity using a calculator and computer keyboard.