Director of Payer Relations
Director of Payer Relations
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Salary Not Disclosed
1 Vacancy
Job Description
Job Details
Description
United Digestive is seeking a Director Payer Relations to join our growing team. The Director plays a pivotal role in our continued success and scaling leading all aspects of UDs efforts to build and strengthen partnerships with major commercial payors.
Critical Outcomes
Develop and implement metricbased nationwide payer relations strategy for the organization
- Develop relationships with top commercial payer leadership including leading regular strategic conversations about access quality and cost
- Devise annual strategic contracting plan across UD footprint; prioritize negotiations across states and service lines
- Secure consolidated nationwide contracts whenever possible
- Incorporate quality data to aid in increased reimbursement or increased volume capture
- Present and receive leadership approval for strategic contracting plan
Lead contract evaluation and strategy for United Digestive expansion in existing and new states
- Analyze current contracted rates to benchmarks and seek improved rates
- Review and codify new target contract language
- Quantify financial impact of TIN changes if applicable
- Develop and implement strategic plan to consolidate and/or integrate TINs
- Lead contract negotiation efforts to secure new contracts and/or rate amendments
- Create databased proposals for contract rate negotiations; analyze counter proposals
- Coordinate credentialing and enrollment needs with Vice President of RCM
- Align scheduling guidelines based on contract inventory by TIN
Maintain accurate contract and rate inventory to ensure appropriate payment is received and contracts are at top of market
- Maintain inventory of key contract terms and renewal dates
- Maintain database of payer contracted fee schedules and benchmarks
- Partner with RCM and payment review software to identify payment concerns; collaborate with RCM to address underpayments with payer representatives
- Utilize PowerBI and payment review software to track measure and analyze payer reimbursements
- Provide notice to payers for contracted rate increases and monitor implementation of such
- Evaluate utilization of and set selfpay rate bundles across organization
Lead collaborative relationships across the organization and with external partners
- Be fully vested and versed in the organizations business model
- Review and analyze Professional Service Agreements across the organization
- Establish regular cadence with CFO Vice President of Finance Vice President of RCM and other leaders to discuss revenue recognition payor contracting and coding reimbursement perspectives
- Partner with other peers and key business leaders to help them identify and access the data insights they need to drive informed decisions
- Coordinate contracting scheduling guidelines and payment review analysis for partner owned/managed endoscopy center IDs such as USPI and Northside Hospital
Monitor payer policy changes and communicate key insights across organization
- Monitor clinical guidelines healthcare regulatory policies and payer policies
- Analyze potential or real impact on business
- Develop strategies to enhance revenue and mitigate risk as policies evolve
- Communicate current payer policy impact summaries to leadership and field as appropriate
Core Leadership Traits & Competencies
Executive presence and entrepreneurship around the core Payer Relations functions:
- Possess strong ability to interact across key company leaders external entities and key contacts
- Possess compelling communication skills to present confidently to executives.
- Bring entrepreneurial thinking.
- Be in execute mode confident enough to take steps to improve the program.
- Roll up your sleeves get into the numbers and be willing to do the work.
Demonstrate proactive inquisitiveness and business savvy:
- Identify the key value levers as well as their sensitivities to other operational factors and market dynamics.
- Proactively identify obstacles between the companys current state and future state and determine strategies to close those gaps.
- Dig for business insights that are not readily available currently and transform the technology in order to acquire further insights needed.
- Proactively brief colleagues on your insights and suggest changes to current operations where appropriate.
- Respond thoughtfully and cogently to key stakeholders including the CFO and CEO.
Be collaborative in assessing options but decisive when needed:
- Work in a collaborative manner. Proactively seek out others opinions before making decisions with strategic implications.
- Coordinate crossfunctionally to ensure effective execution.
- Be willing to lead and make decisive daytoday decisions.
- Be reliable. Once a decision is made ensure followthrough.
Desired Experience
Must Haves:
- 5 years in payer relations preferably with physician services hospital or top commercial payer
- Strong experience in analysis strategy simplification and presentation of complex data sets at the Board level
- Experience working in multisite or national scale payer relations
- Experience in ValueBased Care
- Strong partnership with and knowledge of RCM functions including fee for service billing
Nice to Haves:
- Experience in Gastroenterology Ambulatory Surgery and multistate provider practice
- Lean or SixSigma Certification
- Experience in private equity backed healthcare organizations
- Established relationships within third party payer organizations
Required Experience:
Director
Employment Type
Full-Time
