Director, Payer Contracting - Des Moines, IA

Company: Mercy Medical Center Des Moines ( Learn More )

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General Information
US-IA-Des Moines
N/A
4 Year Degree
Full-Time
Not Specified
Not Specified
False
False
Job Description

Job Summary: 

The Director plans, directs, and coordinates the managed care policies, goals, and objectives related to contract language and rate pricing, negotiation strategy, planning and execution, revenue reconciliation, and payer relationship management.  This position provides strategic leadership, financial and administrative oversight of managed care contracting and operations with commercial, Medicare, and Medicaid managed care payers on behalf of the organization and other related ventures.   The Director works closely with CHI Business Services and health system leadership, clinical departments, finance department, HIM & CDM leaders, and revenue cycle leaders.

Essential Duties:

1.    Develop and manage a portfolio of payer contracts that optimize organization revenue, margin and growth in alignment with CHI’s mission and strategic objectives2.    Establish and maintain positive, appropriate relationships with market payers. Utilize communication and organizational skills to work collaboratively and credibly with payers to achieve common objectives.3.    Work collaboratively with internal stakeholders to define and achieve common payer strategy and reimbursement objectives.   4.    Develop and execute communication plans to internal and external stakeholders related to payer relationships, negotiations, organizational contractual obligations, and developments in the managed care marketplace.5.    Coordinate financial analysis of payer contract performance and modeling projections based on alternate contract agreements with payers, adverse trends, etc, and make appropriate recommendations or conclusions.6.    Analyze and monitor financial aspects of existing managed care contracts.  Utilize analysis for feedback on contract renewals, renegotiations or termination.  Make recommendations regarding participation or non-participation with new or existing agreements.  Provide feedback to Divisional Vice President regarding financial and/or operational issues with payers.7.    Responsible to ensure contract language in compliance with CHI Managed Care Standards & Guidelines.8.    Coordinate with CDM around strategic pricing & coding for contract optimization.
Job RequirementsEducation:

  • Bachelor's degree preferred.
  • Masters in business, healthcare administration or related field is preferred.
Experience:

• Minimum 7 years in health care or managed care industryPrevious experience in the provider industry is highly preferable• Significant knowledge of contractual, administrative, health insurance and operational issues related to managed care organizations, physician groups, hospitals and health insurance benefit plan designs.• Proven and extensive contracting technical skills; negotiation skills, contract preparation and implementation, financial analysis and rate proposal development, and in depth knowledge of various reimbursement methodologies.• Highly developed communication and organizational skillsExperience assessing problems & implementing solutions

License/Certification:

  • None
Additional Responsibilities:

  • Demonstrates a commitment to service, organization values and professionalism through appropriate conduct and demeanor at all times.
  • Adheres to and exhibits our core values: Reverence: Having a profound spirit of awe and respect for all creation, shaping relationships to self, to one another and to God and acknowledging that we hold in trust all that has been given to us.Integrity: Moral wholeness, soundness, uprightness, honesty and sincerity as a basis of trustworthiness. Compassion: Feeling with others, being one with others in their sorrows and joys, rooted in the sense of solidarity as members of the human community.Excellence: Outstanding achievement, merit, virtue; continually surpassing standards to achieve/maintain quality.
  • Maintains confidentiality and protects sensitive data at all times.
  • Adheres to organizational and department specific safety standards and guidelines.
  • Works collaboratively and supports efforts of team members.
  • Demonstrates exceptional customer service and interacts effectively with physicians, patients, residents, visitors, staff and the broader health care community.
Catholic Health Initiatives and its organizations are Equal Opportunity Employers. CBCHI

  • Shift:  1st
  • Scheduled Hours per 2-week Pay Period:  80
  • Weekends Required:  None
  • Status:  Full Time
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