Director of Payor Relations & Contracting



DEPARTMENT: Payor Relations & Contracting

SUPERVISOR'S TITLE: Assistant Vice President, Contracting and Payor Relations
Responsible for the planning, development, direction and maintenance of outside third party payor and provider contracting relationships. Exercises general day- to-day supervision over payor relations department staff engaged in contract negotiations with third party payors. Lead negotiator for major health plans and other third party payors' contract negotiations.

Responsibilities
·Contracting and Negotiations
Working with Revenue Cycle Management and other CCHMC management, to negotiate favorable contract terms for professional, hospital, ancillary and other services for CCHMC and the PHO. Assist in developing and implementing annual contracting plan through individual contract negotiations and directing efforts of contract negotiation staff for CCHMC and PHO.
·Data Analysis and Pricing
Reviews and analyzes all fee schedules for appropriateness and compliance. Recommends annual fee changes and pricing policies. Develop analytical reports to demonstrate financial impact of proposed arrangements for physician, hospital and PHO contracts.
·Contract Management, Implementation and Compliance
Monitor and continually evaluate third party payor contracts in conjunction with staff, AVP, and VP, Revenue Cycle.. Apply an understanding of the multiple methods of reimbursement methodology, contract negotiation philosophies and modeling of financial arrangements to assess impact on CCHMC and PHO. Ensures all contract documents and supporting materials are loaded into contract information system by staff as outlined in processes established by the department. Coordinate implementation activities including acting as liaison to and resource for internal operations and affiliates regarding third party payor contracting. Oversee the resolution of operational and/or compliance issues with the implementation and execution of the third party payor contracts. Track, monitor, evaluate, and distribute changes to medical/reimbursement/prior authorization policies and requirements that are distributed by third party payors.
·Payor Relations/Relationships
Develop and maintain appropriate working relationships with the decision-makers and operating/clinical departments of various third party payor products and insurance companies. Conduct presentations and market CCHMC and PHO to third party payors, including employers, insurance companies; federal, state, local and foreign government payers.
·Financial
Manage annual expenses of department to budget.

Skills & Competencies
·Workflow - Advanced
Advanced skills in organizational and workflow efficiency
·Negotiation
Persuasively articulating one's position, carefully listening to others' positions, and tailoring negotiation tactics to bring all parties together and reach desired outcomes; striking a balance between being firm and being willing to compromise; preserving long-term relationships by demonstrating fairness and searching for win-win solutions
·Computer Proficiency
Proficiency in basic computer applications such as Microsoft Office (PowerPoint, Word, Excel), e-mail, and internet
·Independence
Pursuing work with little supervision or assistance; directing one's own efforts. Demonstrated ability to work independently and as part of a team.
·Organization
Strong organizational and project management skills to handle projects independently.
·Problem Solving
Ability to independently work through details of a problem to reach a positive solution
·Communication - Advanced
Excellent verbal, written and interpersonal communication skills.
·Analytical
Superior analytical ability to evaluate data, make judgments and recommendations regarding strategies, tactics, operations and budgets.

Required:
·Bachelor's Degree in Healthcare Admin., Business Admin., Finance, Accounting
·10 years of related experience including: 2 years of financial and third party payer contract management experience
· Supervisory experience in a complex organization
·Experience with PHO, physician and hospital negotiators in an academic medical center

Preferred:
·Master of Business Admin OR Master of Health Administratn
·Experience resolving operational and/or compliance issues with third-party payors