Director Payer Relations, Surgery Centers

Vail Health has become the world's most advanced mountain healthcare system. Vail Health consists of an updated 520,000-square-foot, 56-bed hospital. This state-of-the-art facility provides exceptional care to all of our patients, with the most beautiful views in the area, located centrally in Vail. Learn more about Vail Health here.

About the opportunity:

The Director of Surgery Center Payer Relations develops and implements new and established contracts for third party payers in connection with Vail Health Surgical Services locations. This position works with all stakeholders aligned with the Summit Orthopedic Surgery Center dba Dillon Surgery Center and Basalt Orthopedic Surgery Center dba Steadman Philipon Surgery Center (physicians, hospitals, pharmacies, ancillary groups & facilities, etc.) to create a geographically competitive, broad access, stable provider network in connection with Vail Health.

What you will do:

Integrates and aligns payer strategy with Vail Health's strategic objectives, including population health strategies, value-based contracting strategies, contract management, operations processes, and government reimbursement trends.

Maximizes operational standards related to third party payment and facilitates enhanced access to the organization for members of the community.

Reviews and negotiates payment terms based on multiple reimbursement models, including fee-for-service payment terms, valued based payments and gain/risk sharing arrangements

Responsible for contract rates aligned with each CPT code table maintenance within the Surgery Center practice management software.

Includes integration (relative to payer strategy) across key functional areas of Revenue Cycle Management, Finance, Decision Support, Legal, Reimbursement, and Business Development]

Leads key payer negotiations with the goals of maintaining adequate operating margins, growing the payer portfolio and advancing value-based pricing logic.

Ensures contract language aligns with all State and Federal laws/regulations and organizational policies.

Ensures contract language includes all appropriate wording to protect Vail Health from capricious changes that adversely impact reimbursement levels or timely payment.

Communicates and provides tools for contractual terms to other departments whose functions are necessary to the development, implementation and management of the provider arrangements .

Maintains knowledge and understanding of healthcare industry trends, standards, and current events relative to provider contracting, network administration and market.

Role models the principles of a Just Culture and Organizational Values.

Performs other duties as assigned. Must be HIPAA compliant.

This description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.

What you will need:

Experience:

Required:

• 5 years leadership experience in connection with managed care contracting and payer relations in a similar environment.
• Demonstrated ability in financial analysis, payment methodologies, contract language, negotiation strategy/tactics, relevant regulatory and compliance issues.

Preferred:

• HST Pathways Practice Management
• Waystar clearinghouse optimized workflow

License(s):

• N/A

Certification(s):

• Healthcare Financial Management Association CRCR preferred

Computer / Typing:

• Must possess, or be able to obtain within 90 days, the computer skills necessary to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.

Must have working knowledge of the English language, including reading, writing, and speaking English.

Education:

• Bachelor's degree in finance, business administration, healthcare management, or a related field. Master's degree preferred.

Benefits at Vail Health (Full Time) Include:

• Competitive Wages & Family Benefits:
  • Competitive wages
  • Parental leave (4 weeks paid)
  • Housing programs
  • Childcare reimbursement
• Comprehensive Health Benefits:
  • Medical
  • Dental
  • Vision
• Educational Programs:
  • Tuition Assistance
  • Existing Student Loan Repayment
  • Specialty Certification Reimbursement
  • Annual Supplemental Educational Funds
• Paid Time Off:
  • Up to five weeks in your first year of employment and continues to grow each year.
• Retirement & Supplemental Insurance:
  • 403(b) Retirement plan with immediate matching
  • Life insurance
  • Short and long-term disability
• Recreation Benefits, Wellness & More:
  • Up to $1,000 annual wellbeing reimbursement
  • Recreation discounts
  • Pet insurance

Pay is based upon relevant education and experience per year.

Yearly Pay:

$130,083.20-$185,827.20 USD