Executive Director of Contracts and Payer Relations Contracting Full-Time Days

ABOUT MARINHEALTH
Are you looking for a place where you are empowered to bring innovation to reality Join MarinHealth an integrated independent healthcare system with deep roots throughout the North Bay. With a worldclass physician and clinical team an affiliation with UCSF Health an everexpanding network of clinics and a new stateoftheart hospital MarinHealth is growing quickly. MarinHealth comprises MarinHealth Medical Center a 327bed hospital in Greenbrae and 55 primary care and specialty clinics in Marin Sonoma and Napa Counties. We attract healthcares most talented trailblazers who appreciate having the best of both worlds: the pioneering medicine of an academic medical center combined with an independent hospitals personalized caring touch.

MarinHealth is already realizing the benefits of impressive growth and has consistently earned high praise and accolades including being Named One of the Top 250 Hospitals Nationwide by Healthgrades receiving a 5star Ranking for Overall Hospital Quality from the Centers for Medicare and Medicaid Services and being named the Best Hospital in San Francisco/Marin by Bay Area Parent among others.

Company:

Marin General Hospital dba MarinHealth Medical Center

Compensation Range:

$92.91 $139.36

Work Shift:

8 Hour (days) (United States of America)

Scheduled Weekly Hours:

40

Job Description Summary:

The Executive Director of Contracts and Payer Relations will report to the Chief Financial Officer and will provide leadership strategic direction and overall management of all contracting and payer relation activities to ensure that the Hospitals contracting objectives are met. The Executive Director will be responsible for leading and implementing both strategic and tactical contracting activities for MarinHealth Medical Center (MHMC) MarinHealth Medical Network (MHMN) (for grandfathered contracts) and related JVs. Contract types include payer contracts and general service and consulting contracts. The role involves interaction with payers vendors physicians and physician office staff as well as various groups within the Hospital and outside of the hospital.

Job Requirements Prerequisites and Essential Functions:

EDUCATION

• Bachelors Degree in Accounting or Business Administration.
• Masters Degree Preferred.

EXPERIENCE

• A minimum of 10 years experience in contracting activities preferable in a healthcare environment.

Prerequisite Skills:

• Demonstrated understanding of medical payment processes and practices.
• Thorough knowledge of contracting economics and outcomes research.
• Experience in negotiating contracts with payers and medical groups.
• High level of interpersonal skills: influencing resolving conflict and creative problem solving. Must be an excellent communicator using all available channels.
• Ability to make effective presentations to all levels of company management Board of Directors physician practice staff and payers.
• Evidence of leadership and a management style characterized by vision teamwork preparation communication and negotiation; a history of successfully managing relationships at all levels of the organization.
• A resultsoriented individual skilled in motivating and inspiring people.
• Strong organizational skills ability to prioritize and complete projects.
• Strong administrative skills
• Experience with health plan and provider contracting functions.
• Effective analytical and problemsolving skills with the ability to manage multiple projects and apply creative solutions to challenges.
• Basic understanding of contact law.
• Ability to think strategically.
• Familiarity with hospital/healthcare service and consulting contracts.
• Strong customer focus.
• Knowledge of payercapitated arrangements and Accountable Care Organizations (ACO) structure and infrastructure.

Essential Duties:

• Develop overall payer strategy for MHMC and its Affiliates and communicate strategy goals and progress to management team contracting team on a regular basis.
• Communicate as necessary to ensure organization wide support of contracting strategies.
• Review and adjust payer targets as environment changes and gain agreement on changing priorities.
• Actively work with the Chief Financial Officer and Chief Executive Officer in the establishment of payer contracting strategies.
• Manage payer contract negotiations within established parameters.
• Identify and recommend additional resources needed (either inhouse or external) to support contracting whether customer or payer focused.
• Manage the relationship with the Third Party Administrators (TPAs) that administer Capitation contracts
• Monitor the outofnetwork services for capitated enrollees and generate single case Letters of Agreement (LOAs) for noncontracted providers.
• Complete credentialing and recredentialing documents for MHMC. MSSC and Marin PET CT
• Track and report high cost patients medical expenses to the MHMC Reinsurance brokers.
• Generate all MHMC Transfer Agreements.
• Provide real time responses to internal department inquiries about UM guidelines authorization requirements contract language about denials appeals and other information applicable to internal department operations.
• Conduct New Leader Training about the contract process and guidelines
• Elevate claims appeals to Health Plan senior contacts when patient Financial Services appeals have not been successful.
• Review service contracts for key legal and business risk/terms. Negotiate with vendors to amend contracts as needed. Recommend changes to FCO

Reasonable accommodation(s) to qualified individuals with disabilities are available as part of the application step. If an accommodation is needed please contact Human Resources ator email to initiate the process.

MarinHealth is a diverse community of people with many different talents. We seek candidates whose work experience has prepared them to contribute to our professional C.A.R.E.S standards (Communication Accountability Respect Excellence and Safety) . These behavioral standards help us create a healing environment for patients and colleagues alike. By committing to them and holding ourselves accountable we can build trust and ensure clear communication.

At MarinHealth our top priority is the wellbeing of our employees patients and community. As such we require all employees to receive necessary immunizations including the measles mumps varicella and seasonal flu vaccinations as a condition of employment and annually thereafter. Additionally the continued recommendation to obtain a COVID booster vaccination status. We understand that some individuals may require medical or religious exemptions from these requirements and we remain committed to prioritizing the health and safety of all. Thank you for helping us in our efforts to maintain a healthy and safe environment.

The compensation for this role listed on this posting is in compliance with applicable law. The selected candidates compensation will be determined based on the individuals skills experience internal/market equity factors and qualifications. This posted minimum and maximum range represents the minimum and maximum of what we reasonably expect to compensate for the position. Furthermore all compensation decisions are ultimately determined in accordance with our compensation philosophy. Compensation for positions covered by collective bargaining agreements are governed by the agreements in the aforementioned document.