Job Description - Director Payer Contract/Ops/Credentialing (302255)
Job Description
Director Payer Contract/Ops/Credentialing-302255
Description
Job Summary
Responsible for technical and professional payer contracting and credentialing for the entire Health System. Provides guidance and support to Senior Leadership in aspects of payer contracting/negotiations, pricing, and delegated credentialing for the Health System. Responsible for pivoting and adapting NCHS to an everchanging payer landscape and reimbursement structure. Be a role model and leader to direct reports and develop a strong educated and impactful team bench.
Job Specific Duties
- Responsible for detailed understanding of health care industry, market dynamics, trends, competitors, regulations, and payer environment.
- Collaborates with the management team and all departmental levels on both the hospital and physician sides. Ensure operational issues are addressed and remedied through negotiation, project planning, or contract modification.
- Creates and maintains professional relationships with payers and potential affiliates.
- Creates, analyzes, and interprets financial reports to support payer negotiations, trends, and audit.
- Implements and communicates contracting strategies in collaboration with Senior Leader.
- Manages all out of network contracting for both hospital and employed physicians.
- Responsible for the management and development of subordinates.
- Knowledge and willingness to support new contracting strategies and approaches. Innovative and out of box thinker
- Provides direction, feedback, and recommendations on trended payer performance; serves as the SME for all payer related contractual arrangements/issues- current and historical.
- Responsible for overseeing the management of all in network and out of network contracting and negotiations for the hospital and employed physician group.
- Responsible for making high impact decisions steeped in judgment.
- Develop and lead Joint Operating Committee meeting with payers and respective NCHS departments.
- Complies with legal and regulatory compliance requirements.
- Leads and oversees Corporate Credentialing function.
Qualifications
Minimum Job Requirements
- Bachelor''s Degree in Business Administration or Health Management
- 7-10 years of management experience in the finance/analytics/accounting field- healthcare related.
- 7-10 years of hospital or payer contracting and negotiating experience.
Knowledge, Skills, and Abilities
- MBA, MHA, and or JD preferred.
- Work well under immense pressure with an ability to focus on multiple priorities while maintaining focus, attention to detail, and connecting all the dots.
- Demonstrated leadership progression.
- Knowledge of Governmental and Commercial payer fee for volume and fee for value reimbursement methods.
- Strong analytical and contract language interpretation skills.
- Familiarity working with Lawyers and interpreting statutes and regulations.
- Business acumen and strong financial skills.
- Excellent written, oral, and communications skills.
- Success in persuasion, influence, and negotiation skills.
- Management expertise, strong knowledge of data analysis, and statistics.
- Able to handle day to day administrative routine, as well as, constantly changing, competing projects, urgent situations, sometimes simultaneously.
- Able to relate cooperatively and constructively with payers and co-workers.
- Effective communicator with a strong, transparent, and clear style; ability to deliver tough messages with tact.
- Effectively monitor and develop the abilities of subordinates.
- Able to maintain confidentiality of sensitive information.
- Knowledge of payer and hospital credentialing function.
- Ability to interpret, adapt, and react calmly under stressful conditions.
- Ability to analyze and interpret complex models and apply to business ask; strong spreadsheet skills.
- Ability to use logical & scientific thinking to interpret technical data and solve a broad range of problems.
- Able to relate cooperatively and constructively with medical staff, executives, staff, elected officials, and managed care companies.
- Independent and self starter with exceptional judgement and time management skills
Job
: Management
Primary Location
: Florida-Miami-NCHS Corporate Headquarters
Department
: NCHS-MANAGED CARE CONTRACTING-1000-900910
Shift
: Days
Job Status: Full Time