Associate Director, Contracting & Payor Partnerships

PRIMARY FUNCTION

The Associate Director of Contracting & Payor Partnerships (West Region) is responsible for creating, maintaining, and managing payor relationships with the Pediatric Associates Family of Companies (PAFC), leading all contracting negotiations and payor partnership initiatives, and providing strategic direction for existing and acquired entity integration for the PAFC West Region (California and Arizona markets). This position reports directly to the SVP of Payor Relationships and works closely with the Payor Enablement and local market teams.

ESSENTIAL DUTIES AND RESPONSIBILITIES

This list may not include all of the duties that may be assigned.

Leads Fee for Service, Capitated and Value-Based negotiations across Medicaid, Commercial, and IFP lines of business to achieve financial targets and ensure compliance with PA Family of Companies contract standards. Identifies contracting opportunities and negotiates rates, terms, and language provisions with payors to maximize reimbursement, reduce exposure, and promote operational efficiencies of scale.

Sets the regional contracting strategy and is responsible for its execution, implementation, and performance in conjunction with local market leadership and the SVP, Payor Relationships.

Initiates and maintains effective channels of communication with matrix partners to vet contract strategy impact, including but not limited to the following areas: Local Market, Credentialing, Legal, Finance, Revenue Cycle, Regional Operations, Compliance, Quality, and Medical Management. Tracks and manages the full life cycle for all payor contracts and amendments from beginning to counter-execution across all payment methodologies.

Develops, manages, and maintains strong external payor partnerships. Leads Joint Operations Committee meetings with payors and represents PAFC as the contracting and performance leader for the West region both internally and externally. Monitors the financial and value-based performance of all payor arrangements and leads discussions with payors regarding contractual, clinical, and financial performance opportunities.

Performs payor-related due diligence activities with regards to prospective acquisition targets; actively manages the contracting and integration of acquired practices.

Works closely with the Director, Payor Partnership Enablement to ensure payor relationships are implemented, operationalized, and maintained across markets in accordance with the associated payor engagement framework. Coordinates with legal and compliance teams to ensure compliance with state and federal regulations for contract terms that may impact contract performance.

Performs special projects as requested/all other duties as assigned.

SUPERVISORY RESPONSIBILITIES

• Heavily matrixed position, requiring influential leadership across national stakeholders.
• Delegates through others and provides accountable oversight for business processes and managed care objectives.
• May manage a direct team.

QUALIFICATIONS

EDUCATION:
A Bachelor's degree in healthcare administration or business is required.

EXPERIENCE:

• Minimum of 6 years combined payor and provider contracting experience required.
• Previous healthcare experience required.
• Knowledge of State Medicaid programs and Managed Care contracting is strongly preferred.

KNOWLEDGE, SKILLS AND ABILITIES

• Understanding of contract language, payment methodologies, value-based reimbursement, and contract performance evaluation spanning Medicaid, IFP and commercial lines of business.
• Strong payor negotiation skills.
• Effective planning and organizational skills with ability to manage multiple priorities and projects.
• Knowledge of Statewide Medicaid Managed Care programs and Commercial payors, with preference given to experience in California and Arizona markets.
• Proficient in research, analysis, and interpretation of financial data and trends.
• Knowledge of claims, credentialing, and loading processes.
• Experience developing, managing, and influencing relationships across a cross-functional and matrixed environment.
• Effective communicator to internal and external audiences, including executives, balanced with strong interpersonal skills.
• A team player with experience in complex environments with the ability to build consensus among divergent interests and competing organizational needs.
• Displays and exemplifies a servant leadership mentality.
• Advanced Microsoft Office skills.

TYPICAL WORKING CONDITIONS

• Non-patient facing
• May be either full-time remote or on site
• Must be U.S. based
• Regional travel up to 15%

OTHER PHYSICAL REQUIREMENTS

• Vision
• Sense of sound
• Sense of touch

PERFORMANCE REQUIREMENTS

Adhere to all organizational information security policies and protect all sensitive information, including but not limited to PHI (Protected Health Information) and ePHI, in accordance with organizational policy, federal, state, and local laws and regulations. Comply with all federal, state, and local laws & regulations in the states where the Pediatric Family of Companies operates.