Director Payer Contract/Credentialing (Managed Care Dept)
Job Description - Director Payer Contract/Credentialing (Managed Care Dept) (27409)
Ā *Remote Candidates Welcome to Apply**
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
Ā Responsible for detailed understanding of health care industry, market dynamics, trends, competitors, regulations, and payer environment.
Ā 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.
Ā Creates and maintains professional relationships with payers and potential affiliates.
Ā Creates, analyzes, and interprets financial reports to support payer negotiations, trends, and audit.
Ā Implements and communicates contracting strategies in collaboration with Senior Leader.
Ā Manages all out of network contracting for both hospital and employed physicians.
Ā Responsible for the management and development of subordinates.
Ā Knowledge and willingness to support new value based transformational contracting strategy at the right time in the right setting.
Ā Provides direction, feedback, and recommendations on trended payer performance; serves as the SME for all payer related contractual arrangements/issues- current and historical.
Ā Responsible for overseeing the management of all in network and out of network contracting and negotiations for the hospital and employed physician group.
Ā Responsible for making high impact decisions steeped in judgment.
Ā Develop and lead Joint Operating Committee meeting with payers and respective NCHS departments.
Ā Complies with legal and regulatory compliance requirements.
Ā Leads and oversees Corporate Pricing function.
Ā Leads and oversees Corporate Credentialing function.
Qualifications
Ā Bachelor's Degree in Business Administration or Health Management
Ā 4-7 years of management experience in the healthcare finance/payer/managed care contracting field
Ā 7-10 years of hospital and/or payer negotiations and analysis experience
Knowledge, Skills, and Abilities
Ā MBA or MHA preferred.
Ā Work well under immense pressure with an ability to focus on multiple priorities while maintaining focus, attention to detail, and connecting all the dots.
Ā Demonstrated leadership progression.
Ā Knowledge of fee for volume and fee for value reimbursement methods.
Ā Strong contract review and interpretation skills.
Ā Familiarity working with Lawyers and interpreting statutes and regulations.
Ā Business acumen and strong financial skills.
Ā Excellent written, oral, and communications skills.
Ā Success in persuasion, influence, and negotiation skills.
Ā Management expertise, strong knowledge of data analysis, and statistics.
Ā Able to handle day to day administrative routine, as well as, constantly changing, competing projects, urgent situations, sometimes simultaneously.
Ā Able to relate cooperatively and constructively with payers and co-workers.
Ā Effective communicator with a strong, transparent, and clear style; ability to deliver tough messages with tact.
Ā Effectively monitor and develop the abilities of subordinates.
Ā Able to maintain confidentiality of sensitive information.
Ā Knowledge of payer and hospital credentialing function.
Ā Ability to interpret, adapt, and react calmly under stressful conditions.
Ā Ability to analyze and interpret complex models and apply to business ask; strong spreadsheet skills.
Ā Ability to use logical & scientific thinking to interpret technical data and solve a broad range of problems.
Ā Able to relate cooperatively and constructively with medical staff, executives, staff, elected officials, and managed care companies.
Job: Management
Primary Location
Department: NCHS-MANAGED CARE CONTRACTING-1000-900910
Apply Now
Ā *Remote Candidates Welcome to Apply**
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
Ā Responsible for detailed understanding of health care industry, market dynamics, trends, competitors, regulations, and payer environment.
Ā 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.
Ā Creates and maintains professional relationships with payers and potential affiliates.
Ā Creates, analyzes, and interprets financial reports to support payer negotiations, trends, and audit.
Ā Implements and communicates contracting strategies in collaboration with Senior Leader.
Ā Manages all out of network contracting for both hospital and employed physicians.
Ā Responsible for the management and development of subordinates.
Ā Knowledge and willingness to support new value based transformational contracting strategy at the right time in the right setting.
Ā Provides direction, feedback, and recommendations on trended payer performance; serves as the SME for all payer related contractual arrangements/issues- current and historical.
Ā Responsible for overseeing the management of all in network and out of network contracting and negotiations for the hospital and employed physician group.
Ā Responsible for making high impact decisions steeped in judgment.
Ā Develop and lead Joint Operating Committee meeting with payers and respective NCHS departments.
Ā Complies with legal and regulatory compliance requirements.
Ā Leads and oversees Corporate Pricing function.
Ā Leads and oversees Corporate Credentialing function.
Qualifications
Ā Bachelor's Degree in Business Administration or Health Management
Ā 4-7 years of management experience in the healthcare finance/payer/managed care contracting field
Ā 7-10 years of hospital and/or payer negotiations and analysis experience
Knowledge, Skills, and Abilities
Ā MBA or MHA preferred.
Ā Work well under immense pressure with an ability to focus on multiple priorities while maintaining focus, attention to detail, and connecting all the dots.
Ā Demonstrated leadership progression.
Ā Knowledge of fee for volume and fee for value reimbursement methods.
Ā Strong contract review and interpretation skills.
Ā Familiarity working with Lawyers and interpreting statutes and regulations.
Ā Business acumen and strong financial skills.
Ā Excellent written, oral, and communications skills.
Ā Success in persuasion, influence, and negotiation skills.
Ā Management expertise, strong knowledge of data analysis, and statistics.
Ā Able to handle day to day administrative routine, as well as, constantly changing, competing projects, urgent situations, sometimes simultaneously.
Ā Able to relate cooperatively and constructively with payers and co-workers.
Ā Effective communicator with a strong, transparent, and clear style; ability to deliver tough messages with tact.
Ā Effectively monitor and develop the abilities of subordinates.
Ā Able to maintain confidentiality of sensitive information.
Ā Knowledge of payer and hospital credentialing function.
Ā Ability to interpret, adapt, and react calmly under stressful conditions.
Ā Ability to analyze and interpret complex models and apply to business ask; strong spreadsheet skills.
Ā Ability to use logical & scientific thinking to interpret technical data and solve a broad range of problems.
Ā Able to relate cooperatively and constructively with medical staff, executives, staff, elected officials, and managed care companies.
Job: Management
Primary Location
Department: NCHS-MANAGED CARE CONTRACTING-1000-900910
Apply Now