Senior Director-Payor Contracting bei WellSpan Medical Group

Duties and Responsibilities
 

• Manages all new as well as timely renewals of System contracts, including new hospital additions as applicable, in accordance with System Care Contracting Team. Includes all traditional medical components (hospital, WMG, Apple Hill, rehab/surgery hospital, home infusion, VNA, DME) and Value-Based Purchasing.
• Collaborates with contracting leadership to identify and understand challenging operational issues with payor contract compliance and develops and modifies contracting language to be incorporated into future contracts or contract amendments to minimize operational difficulties. Engages on contract negotiations to ensure operational success and reduction in revenue balances. Collaborates on organizational finance tools, annual budget, and five-year outlooks.
• Collaborates with leadership on identifying opportunities and challenges related to Value-Based Purchasing agreements and revenue opportunities
• Manages the development and maintenance of the System’s preferred standard contracting terms to be incorporated into new or revised contracts.
• Manages and develops processes to ensure the System is compliant with contract notification terms, including: annual price increases, change in services, change in sites, etc. Ensures clear and timely communication and updates provided to analytics team.
• Develops and maintains system payor contract summary with key details, including line of business, effective date, end date, termination notice period, COLA/CM date and percentages.
• Develops processes, to collect and maintain available market information regarding market payment rates and methods for various types of managed care payors: including Medicare, Medical Assistance, & Commercial managed care payors.
• Oversees working with appropriate ancillary department personnel in the maintenance and execution of payor contracts (BHU, Rx, Dental, lab, WC).
• Leads the weekly team huddles, monthly team meetings, individual one on one meetings with direct reports, monthly Payor Contracting Update meetings for internal matrix partners.
• Maintains a strong knowledge of all pertinent governmental regulations that pertain to both payor contracts and hospital operations (i.e., Act 68, HIPAA, Surprise Billing) ensuring appropriate compliance requirements are kept by departmental personnel as applicable.
• Assists the VP of Payor Contracting and Population Health in projects, presentations, and negotiation updates.
• Summarizes negotiations (starting point, updates, and final results) for a variety of leadership forums utilizing presentation skills and tools.
• Manages contract terminations, including internal communications and matrix partner collaborations.
• Responsible for the direct leadership and mentorship of Payor Contracting Negotiators.

Qualifications

Minimum Education:

• Bachelors Degree Finance, Healthcare Administration, or related field Required
• Masters Degree Business or Healthcare Administration Preferred

Work Experience:

• 10+ years Experience in Third party payor contracting, Accounting, Patient Accounting, or Government Regulations Required and
• Supervisory experience. Required
• Healthcare reimbursement, third party payor or regulatory experience. Preferred

Knowledge, Skills, and Abilities:

• Excellent computer skills
• Excellent oral and written communication skills
• Data and analytics knowledge

Benefits Offered:

• Comprehensive health benefits
• Flexible spending and health savings accounts
• Retirement savings plan
• Paid time off (PTO)
• Short-term disability
• Education assistance
• Financial education and support, including DailyPay
• Wellness and Wellbeing programs
• Caregiver support via Wellthy
• Childcare referral service via Wellthy