CityMD

Director, Payor Strategy & Contracting

US-NY-NYC
ID
2017-1578
Category
Other

Overview

Job purpose

The successful candidate will work collaboratively with a diverse team to oversee managed care contracting, including managing insurance company relations; assisting on all contract negotiations for all states where the Company operates; providing input and support for value-based programs; and conducting research and analysis for future contracts, programs, projects and policies. The ability to influence and motivate others, as well as work collaboratively within a multi-stakeholder environment is key.

Responsibilities

The primary duties and responsibilities of a Director of Payor Strategy & Contracting:

  • Develop and evaluate payment rates and strategies for managed care contracting. Analyze, develop, and revise models to support contract negotiations. Help develop strategies for maximization of managed care reimbursement and minimization of operational costs.
  • Monitor and manage all payer contracts. Run alternate contract models to determine current contract performance vs. proposed contract structure and rates.
  • Monitor, inform appropriate parties, and respond timely to Managed Care contract anniversary dates; provide all required notices and updates to payers as required under applicable managed care contracts.
  • Interact with managed care companies’ contracting representatives.
  • Coordinate with General Counsel for all Legal issues and approval of managed care agreements. Assist in managed care contract language review for existing and new managed care contracts. Develop written summaries of all executed contracts for distribution to key staff members to communicate to them contract terms.
  • Support in design, development, participation and performance monitoring of various quality and value programs. Help prepare clinical and administrative data submission to support participation in programs.
  • Assist in the completion of assignments related to the preparation of presentations and reports; oversee monthly reporting of Managed Care operations to the executive leadership team.
  • Work closely with Revenue Cycle Management in the audit of payments to ensure payer compliance with contract payment methodologies. Assist with statistical and financial models and analysis for special financial projects prepared for internal and external review.
  • Address payer non-performance issues under managed care contracts as identified by Billing Department.
  • Communicates with various departments, including Revenue Cycle Management and Credentialing, Operations, Health System Partnerships, the CMO and others, to ensure appropriate coordination and support of system wide strategic, financial and operational objectives.
  • Ability to work with IT and Operations to assist in implementation of technologies such as Contract Management solutions and patient estimators.
  • Assists in the developments of policies and procedures to adhere to the contractual agreements.
  • Leads development and implementation of successful strategies/solutions to achieve goals.
  • Actively works to strengthen existing business partnerships and pursue the development of future partnerships.
  • Perform payer-specific reporting and analysis of healthcare industry trends including the impact of government regulations.
  • Understands Coding requirements / regulations and is able to provide guidance on best practices.
  • Stays abreast of industry trends related to PPACA, Medicaid Reform, Physician Employment Models, Value trends, etc. to secure the Company’s long-term viability and success.
  • Responsible for performing all other duties as assigned.

Qualifications

  • Bachelor's degree required, Masters (MBA, MHA, MPH) preferred 
  • A minimum of five years of health care leadership experience required in managed care with emphasis on managed care strategic planning, contracting for hospital/ancillary/physician services and contract management; familiarity with value based contracting and new reimbursement payment models
  • Strong entrepreneurial orientation with the ability to critically think and act decisively to effectively impact business goals
  • Successful track record selling innovative products offerings and services internally to executives and externally to payers
  • Work requires analytical ability to collect information from diverse sources and apply professional principles in performing various analyses, and summarize the information and data in order to solve problems
  • Experience with data analytics platforms such as Domo is a plus
  • Outstanding interpersonal capabilities and ability to interface with all levels of an organization and navigate various dynamics
  • Ability to manage multiple projects with competing priorities
  • Ability to operate in a fluid environment
  • Strong presentation and communication skills
  • Self-starter who will aggressively advance the team’s business goals

Physical requirements

This job may require, from time to time, repetitive tasks with few breaks.

Limited travel (<10%) is required

Direct reports

None

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