Director - Payer Relations

Responsible to contribute to the growth and profitability of Billings Clinic by professionally managing services and activities for service line and for strategic planning and administration of Billings Clinic. Responsible for corporate administration of external relations with payers, joint ventures, vendors, providers, and others. Responsibilities also include program direction, development and marketing for the Senior Life Partners, Lifeline and Elder Care Solutions service lines to enhance quality of service offerings and explores/develops opportunities for cooperative ventures with external senior service providers. Researches health-related products/services that enhance senior services offered by Billings Clinic.

Essential Job Functions

• Develops, implements and assists in the advancement of the mission, vision, and values of Billings Clinic establishing a vision of excellence with a customer service orientation and demonstrated quality outcomes.
• Participates in establishing philosophy and culture of Billings Clinic. Leads groups through strategic planning sessions and motivates team to execute strategic objectives.
• Responsibilities include the promotion of, adherence to, the elements of Billings Clinic Code of Business Conduct and the corporate compliance program.
• Ensures the success and credibility of Billings Clinic through the delivery of innovative, quality, cost efficient programs. Leads the administration and ongoing refinement of comprehensive programs, including well defined protocols, policies and procedures assuring high quality standards and the cost effective delivery of the appropriate level of care in the appropriate care delivery setting. Assures the highest standard of clinical outcomes, patient satisfaction, and responsive/accessible customer service. Provides consultation services for community and health care providers.
• Leads service lines in marketing, program development, and service priorities. Coordinates with physicians and other Billings Clinic leadership to assure continuity in pursing system goals and synergy in implementing plans. Identifies and addresses synergies/problems across service lines, providers, and within the community. Communicates relevant developments to staff.
• Develops/maintains financial and budgetary goals/objectives and oversees/assists with the development of departmental business plans which support Billings Clinic goals and objectives. Communicates and coordinates corporate and administrative information for use by Billings Clinic leadership and governing bodies, including feasibilities, projections, and results reporting.
• Practices process improvement principles and oversees assessment and improvement of the quality of the service and patient care provided. Maintains competency in all organizational, departmental and outside agency safety standards relevant to services provided and ensures compliance.
• Develops, retains, recruits, and leads a talented management team committed to accomplishing the goals and objectives of Billings Clinic. Conducts appropriate performance actions to include motivation, training, coaching, and counseling of employees. Acts as a mentor, promotes and encourages professional growth and development of all staff. Takes responsibility for own professional growth and development needs; meets all system educational requirements.
• Establishes culture and standards; participates, fosters, demonstrates and encourages an ethic of open communication and teamwork throughout the organization and in the community. Builds an environment of shared commitment to Billings Clinic goals and responsibility to achieve quality outcomes. Maintains a high level of satisfaction within Billings Clinic among physicians and employees by providing an environment conducive to maximum individual and collective productivity. Provides consultation for related concerns and acts as a customer and community advocate by demonstrating sensitivity to ethical and legal ramifications of practice.
• Participates in evaluating, selecting and integrating health care technology and information systems that support quality of care, financial needs and efficient use of resources. Assures information systems meet the objective of providing appropriate, accurate, and timely information to all internal and external constituencies.
• Participates in establishing Billings Clinic's strategic goals. Translates all goals possible into Payer Relations strategies and tactics.
• Conducts payer relationships, develops/negotiates contracts and manages payer compliance functions.
• Contract Negotiation
• Provide timely recommendations regarding new and existing contracts with payers.
• Evaluate contract language and terms against requirements
• Evaluate rate schedules against targets for net revenue
• Ensure that contract requirements, including rates, can be effectively and efficiently administered by staff
• Ensure that all exhibits are consistent with requirements and incorporated in the Agreement
• Evaluate new contracts against industry and Billings Clinic standards. Apply standards based on the provider type (hospital verses physician verses ancillary)
• Coordinate with legal counsel and appropriate staff during contract evaluations. Incorporate staff feedback into contract negotiations.
• Negotiate contract terms and reimbursement rates with payer's plans
• Support effective overall contract negotiations
• Provide background information as to strategic and business opportunities
• Develop financial and reimbursement models
• Describe key contract provisions
• Contract Implementation
• Notify appropriate staff of new and renewed contracts
• Provide contract cover sheet for staff that describes key term and contracts and maintain database of executed contracts that includes current information on contracts and key provisions
• Respond to inquiries from staff concerning contract implementation
• Develop and maintain positive working relationships with payers contacts for purposes of communication and problem solving
• Schedule meetings as needed between payer contacts and staff for purposes of communication and problem solving
• Maintain regular communications with payer contacts concerning company developments, issues, market opportunities, etc.
• Serve as liaison and trouble-shooter between payers and Billings Clinic
• Maintain highest standards of service recovery for all parties
• Contract Compliance
• Monitor payer contracts for compliance issues
• Develop and maintain tools to monitor non-compliance by payers (e.g. prompt payment, denials, accuracy of payment, industry standards, etc.)
• Maintain regular communications with appropriate staff concerning compliance issues
• Schedule regular meetings as needed
• Assist staff and managed care plans with contract compliance issues
• Assess Performance of Payer Contracts (Commercial & Government)
• Assist with development and maintenance of payer performance reports
• Include quantitative criteria such as days in A/R, underpayment, write-off percentages, etc.
• Include qualitative criteria such as customer service, communications responsiveness, accessibility, etc.
• Obtain feedback from staff concerning payer performance
• Market Intelligence/Payer Plan Relations
• Provide employer/payer plan updates, including number of covered lives, health plan renewal dates, key contacts, etc.
• Identify and evaluate opportunities to build relationships with employers and payers in the region
• Monitor local, state and national payer trends
• Provider Enrollment
• Oversee enrollment of Billings Clinic providers in insurance plans
• Maintain database of providers and plans
• Troubleshoot issues with plan enrollments and act as a liaison with internal and external cohorts
• Operations
• Make recommendations regarding payer relations operations and budget to ensure efficient use of resources and focus on strategic priorities
• Work with other departments to facilitate efficient and effective payer relations
• Directs, develops and markets senior services/programs to enhance quality of service offerings and explores/develops opportunities for cooperative ventures with external senior service providers. Researches health-related products/services that enhance senior services offered by Billings Clinic.
• Performs all other duties as assigned to meet the needs of the departments, service lines, and organization.