Director Payer Contract/Credentialing (Managed Care Dept)

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*Remote Candidates Welcome to Apply

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Job Summary

Responsible for technical and professional payer contracting, credentialing, and pricing for the entire Health System.

Provide  guidance and support to Senior Leadership in aspects of payer contracting/negotiations, pricing, and delegated credentialing for the Health System.

Responsible for pivoting and adapting NCHS to an everchanging payer landscape and reimbursement structure.

Be a role model and leader to subordinates and develop a strong educated and impactful team bench.

Job Specific Duties


* Responsible for detailed understanding of health care industry, market dynamics, trends, competitors, regulations, and payer environment.


* Collaborates with the management team and all departmental levels on both the hospital and physician sides.

 Ensure operational issues are addressed and remedied through negotiation, project planning, or contract modification. 


* Creates and maintains professional relationships with payers and potential affiliates. 


* Creates, analyzes, and interprets financial reports to support payer negotiations, trends, and audit.


* Implements and communicates contracting strategies in collaboration with  Senior Leader. 


* Manages all out of network contracting for both hospital and employed physicians. 


* Responsible for the management and development of subordinates. 


* Knowledge and willingness to support new value based transformational contracting strategy at the right time in the right setting. 


* Provides direction, feedback, and recommendations on trended payer performance; serves as the SME for all payer related contractual arrangements/issues- current and historical. 


* Responsible for overseeing the management of all in network and out of network contracting and negotiations for the hospital and employed physician group. 


* Responsible for making high impact decisions steeped in judgment. 


* Develop and lead Joint Operating Committee meeting with payers and respective NCHS departments. 


* Complies with legal and regulatory compliance requirements. 


* Leads and oversees Corporate Pricing function.


* Leads and oversees Corporate Credentialing function.

Minimum Job Requirements


* Bachelor's Degree in Business Administration or Health Management


* 4-7 years of management experience in the healthcare finance/payer/managed care contracting field


* 7-10 years of hospital and/or payer negotiations and analysis experience

Knowledge, Skills, and Abilities


* MBA or MHA preferred.


* Work well under immense pressure with an ability to focus on multiple priorities while maintaining focus, attention to detail, and connecting all the dots.


* Demonstrated leadership progression.


* Knowledge of fee for volume and fee for value reimbursement methods.


* Strong contract review and interpretation skills.


* Familiarity working with Lawyers and interpreting statutes and regulations.


* Business acumen and strong financial skills.


* Excellent written, oral, and communications skills.


* Success in persuasion, influence, and negotiation skills.


* Management expertise, strong knowledge of data analysis, and statistics.


* Able to handle day to day administrative routine, as well as, constantly changing, competing projects,  urgent situations, sometimes simultaneously.


* Able to relate cooperatively and constructively with payers and co-workers.


* Effective communicator with a strong, transparent, and clear style; ability to deliver tough messages with tact.


* Effectively monitor and develop the abilities of subordinates.


* Able to maintain confidentiality of sensitive information.


* Knowledge of payer and hospital credentialing function.


* Ability to interpret, adapt, and react calmly under stressful conditions.


* Ability to analyze and interpret complex models and apply to business ask; strong spreadsheet skills.


* Ability to use logical & scientific thinking to interpret technical data and solve a broad range of problems.


* Able to relate cooperatively and constructively with medical staff, executives, staff, elected officials, and managed care companies.
 

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