Director, Payor Relations & Contracting
City/State: Fredericksburg, Virginia
Category: Healthcare Leader
Position Hours: 40Apply
Job Requisition Number: R-115
Job Department: 1007011 MWHC-Revenue Cycle Leadership
Job Posted Date: Sep 28, 2020
Start the day excited to make a difference…end the day knowing you did. Come join our team.Job Summary:
This position reports directly to the Vice President of Revenue Cycle and is responsible for Payor Relations and Contracting and the Hospital Charge-master at Mary Washington Healthcare (MWHC). The Director oversees the activities of the Payor Relations and Contracting staff; identifies new business opportunities; and builds relationships with health care payers by negotiating, implementing and monitoring managed care contracts. The Director oversees and develops contract modeling, profitability reporting and contract performance analysis. Additionally, the incumbent of this position directs the work of departmental Associates to ensure reimbursement is optimized. This position must demonstrate a commitment of quality service to our patients, the public and our co-workers.
Essential Functions & Responsibilities:
- Collaborates with executive leadership in the development of MWHC’s annual contracting and payer relations strategy.
- Develops and implements the department’s operational plan relative to the contracting and payer relations strategy; sets and determines steps to meet departmental goals; reviews results and makes revisions to the plan and goals as necessary. Communicates plan and results to senior leadership.
- Negotiates provider agreements in coordination with the Chief Financial Officer, Vice President of Revenue Cycle, and management of other affected departments or providers.
- Strategically develops collaborative relationships with Managed Care plans, Physicians, other allied providers, and area employers regarding the organization's managed care business. Researches and seeks out new business opportunities.
- Develops and monitors a mechanism that tracks the performance of managed care relationships; reviews results and develops action plans.
- Procures, constructs, and reviews managed care contracts; directs the implementation of the contracts with all supporting departments and managed care organizations. Provides follow up support and consultation with all provider agreements.
- Develops, implements, reviews, and revises departmental policies and procedures.
- Develops organizational product lines and related business plans.
- Develops contract management tools and information systems for internal use by various departments based upon specific departmental needs and goals.
- Oversees Associates work on the Charge-master to ensure integrity and accuracy; performs system audits and works with high error departments to resolve concerns. Collaborates with Revenue Cycle and Clinical leadership to increase awareness of charge entry and other revenue related guidelines in relation to reimbursement.
- Develops and communicates the yearly strategic pricing analysis; collaborates with team members to develop the analysis and compile results.
- Reviews, communicates, and implements the yearly CPT code changes. Participates in the completion of surveys.
- Develops and implements operating budget; accountable for the department’s financial performance and fiscal responsibility.
- Provides management and supervision of Associates, including selection, training, and development. Provides feedback on performance and conducts annual performance evaluations.
- Attends external/internal events to keep abreast of current methodologies and approaches.
- Performs other duties as assigned.
- Bachelor's degree in a relevant discipline in healthcare management, business administration, finance or related area. Master's degree preferred.
- Minimum of five years of healthcare related experience in managed care working directly with payers, providers and intermediaries required.
- Minimum of two years of management/supervisory experience required.
- Experience with contract negotiations and developing payer/provider relationships required.
- Experience using Microsoft Office software required.
- Strong verbal, written and presentation skills required.
As an EOE/AA employer, the organization will not discriminate in its employment practices due to an applicant's race, color, religion, sex, sexual orientation, gender identity, national origin, and veteran or disability status.