Director of Payor Strategy and Contracting

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HSS is consistently among the top-ranked hospitals for orthopedics and rheumatology by U.S. News & World Report. As a recipient of the Magnet Award for Nursing Excellence, HSS was the first hospital in New York City to receive the distinguished designation. Whether you are early in your career or an expert in your field, you will find HSS an innovative, supportive and inclusive environment.

Working with colleagues who love what they do and are deeply committed to our Mission, you too can be part of our transformation across the enterprise.

Emp Status
Regular Full time

Work Shift
Day (United States of America)

Compensation Range
The base pay scale for this position is $108,000.00 - $165,000.00. In addition, this position will be eligible for additional benefits consistent with the role. The salary of the finalist selected for this role will be determined based on various factors, including but not limited to: scope of role, level of experience, education, accomplishments, internal equity, budget, and subject to Fair Market Value evaluation. The hiring range listed is a good faith determination of potential compensation at the time of this job advertisement and may be modified in the future.

What you will be doing

Director, Payor Strategy and Contracting

Full-Time

Overview:

Reporting directly to the Assistant Vice President, Payor Strategy and Contracting, the Director Payor Strategy and Contracting will be primarily responsible for the negotiation, implementation, and oversight of all payor contracts. The Director will work closely with the analytics team to model all contract proposals including fee for service and value-based arrangements (i.e., shared savings, bundles, etc.). They will work closely with the Account Management Team to trouble shoot contract operational issues and assist where necessary to bring them to resolution using their understanding of the underlying contracts as well as by leveraging their payor relationships. The Director will provide managerial oversight to the Payor Contract Manager.

RESPONSIBILITIES:

• Meets with senior leadership to ascertain strategic payor contracting goals.
• Analyzes payor contract proposals in conjunction with the analytics team to ensure contracts meet financial goals.
• Negotiates contracts ensuring financial and strategic goals are translated into contractual language accordingly.
• Works closely with the legal team to review and redline contracts as appropriate.
• Ensures internal stakeholders are aware of contract terms and reimbursement rates and that contract terms are appropriately communicated/translated into front and back-end processes.
• Works closely with the revenue cycle teams to ensure contracts are loaded appropriately into billing and decision support systems.
• Works closely with the Account Management team, UM/clinical denials team, and Patient Financial Services and/or the Central Billing Office to identify trends and opportunities in outstanding Accounts Receivables.
• Escalates issues as necessary to payer contacts for resolution. In conjunction with Account Management, recommends escalation as appropriate to senior management.
• Identifies trends/patterned issues to aid in contract re-negotiations.
• Assesses contract administrative terms and advises leadership accordingly on measures of contract performance.
• Maintains up to date knowledge on the healthcare market and reimbursement trends.
• Possesses strong leadership skills and demonstrates capability to inspire staff to pursue excellence in goals and productivity; capable of coaching and improving staff in need of professional development. Places high priority on overall team performance.
• Additional responsibilities as required to accomplish departmental goals.

EXPERIENCE, COMPETENCIES, AND PERSONAL CHARACTERISTICS:

• Experience (7+ years) in payor or provider contracting, provider network oversight and/or revenue cycle management. Major teaching/surgical hospital experience or health plan experience is highly desirable.
• Experience managing and leading a professional team.
• Experience dealing with payors, patient financial services professionals, providers, and their billing staff.
• Possesses key payor contacts and knowledge of payor contracting.
• Detail oriented.
• Knowledge of the healthcare industry and payor reimbursement methodologies (both hospital and physician).
• Ability to work independently and collaboratively to solve complex problems.
• The ability to influence and motivate others, as well as work collaboratively within a multi-stakeholder environment is required.
• Excellent verbal and written communication skills.
• Excellent organizational and multi-tasking skills.
• Is professional when dealing with stakeholders. Uses good judgement and takes a thoughtful approach to resolving and communicating issues.

EDUCATION:

• Bachelor's degree in health or business administration, economics or related subject is required. Masters preferred.

Non-Discrimination Policy
Hospital for Special Surgery is committed to providing high quality care and skilled, compassionate, reliable service to our community in a safe and healing environment. Consistent with this commitment, Hospital for Special Surgery provides care, admits, and treats patients and provides all services without regard to age, race, color, creed, ethnicity, religion, national origin, culture, language, physical or mental disability, socioeconomic status, veteran or military status, marital status, sex, sexual orientation, gender identity or expression, or any other basis prohibited by federal, state, or local law or by accreditation standards.