Director, System Payer Contracting

Department/Unit:
Integrated Delivery Systems

Work Shift:
Day (United States of America)

Salary Range:
$133,724.95 - $213,959.93

The Director is responsible for overseeing as well as implementing, developing, maintaining, and benchmarking contractual relationships with payers/health plans in the AMHS market. Leading and mentoring, negotiating, continuous monitoring of contract performance, and engaging with internal and external stakeholders to optimize contracts or mediate issues requires the Director to possess exceptional leadership, organizational, analytic, and communication capabilities. The Director ensures the team is leveraging multiple sources of data across the AMHS to facilitate best outcomes. To facilitate this, the Director is the primary liaison with AMHS analytics leadership. The Director oversees and leads the day to day operational, programmatic, financial, and employee related activities, as applicable, under the System Payer Contracting Unit. The Director prepares annual budget target recommendations in conjunction with AMHS Finance and other stakeholders.

The Director possesses deep marketplace and payer contracting expertise to meet the high level, multifaceted competencies needed for the implementation and management of payer contracting strategies including building solid external payer relationships on behalf of all entities under the Albany Med Health System (AMHS).

The Director independently negotiates with established and new payers including leading economic assessments and overseeing contract implementation aligned with contract terms. The Director is skilled at drafting, analyzing, and negotiating complex payer contracts. The Director develops contract proposals and leads in meetings, negotiations, presentations, and other contracting related functions. The Director mentors and coaches the team building on competencies enhancing professional development and retention. The Director must work within a highly matrixed environment cultivating strong internal working relationships often managing and influencing stakeholders across AMHS including but not limited to physician and hospital clinical leadership, legal, compliance, billing, finance, IT, case and utilization management, quality, credentialing, and other related departments. The Director builds external relationships with payers' senior network management, leads meeting, oversees and/or prepares presentations, and is responsible for meeting budgetary and other established targets. Additionally, the Director continuously assesses payment and market opportunities in alignment with the AMHS Strategic Plan, including risk based/value-based initiatives. The Director concisely consolidates and presents such opportunities to key stakeholders and senior organizational leadership to influence and support AMHS's continued evolution of its payer contracting strategies. The Director works together with the Vice President to continuously evolve AMHS's payer strategies.

Essential Duties and Responsibilities

• Strategic and Operational Planning
  • Contributes to System payer contracting strategic planning, budgets, and evaluation of payer partnerships.
  • Forecasts and reports on market disruptions; stays on top of national and local payer trends.
• Planning and Program Development and Oversight
  • Identifies, facilitates, and builds systems and standardized processes to facilitate multi-stakeholder collaboration on payer contracts to achieve best negotiation outcomes.
  • Develops timely, efficient payer issues escalation processes in support of revenue cycle and/or clinical operations that promotes payer accountability.
  • Develops payer scorecard initiatives to measure payer compliance with contract terms and overall efficiency of payer operations; leads reviews with payers providing constructive feedback with aligned expectations.
  • Develops and implements systematic payer contracting processes and procedures in order to ensure timely renewals, appropriate maintenance, and System-wide stakeholder education on contract terms and provisions.
  • Forecasts and reports on national and local market trends including change management recommendations in the event of a pending market disruption; completes SWOT analyses.
  • Creates annual goals and objectives for each contracted payer to ensure accountability and responsiveness
• Administrative and Cross-Functional Leadership
  • Collaborates with various departments throughout AMHS to ensure payer contracting initiatives are integrated and aligned with broader organizational goals.
  • Identifies and incorporates innovative payment models and initiatives aligned to enhance patient care and support operations.
  • Ensures adherence to all federal, state, and local regulations for governing payer contracting, stays informed of the health care regulatory environment to mitigate risks.
  • Engages staff and other stakeholders in continuous improvement of systems and processes; effectively manages resources, activities, and people.
• Influence and Relationship Management
  • Exercises influence over payers to advance AMHS's interests, guiding negotiations and contracts towards favorable outcomes.
  • Builds and manages relationships with existing and potential payer organizations ensuring effective communications and problem solving to maintain satisfactory payer partnerships.
  • Promotes AMHS's value to payer constituency.
  • Builds and manages relationships internal to AMHS across disparate departments.
  • Leads disparate groups in problem solving exercises resulting in favorable outcomes.
• Unit, Staff, and Personal Development
  • Builds, leads, and develops a team of payer contracting professionals providing training and resources.
  • Fosters team's growth and sets a high standard.
  • Ensures the team and self take advantage of leadership training, self-development and learning opportunities.

Qualifications

• Bachelor's Degree in a relevant subject area such as Accounting, Finance, Business or Health Care Administration - required
• Master's Degree in a relevant subject area such as Business or Health Care Administration - preferred
• 10+ years relevant experience in the management and negotiation of health care payer contracts and network management experience in an insurance or health care setting - required
• three (3) years of experience managing departmental resources including people - required
• Five (5) or more years of management experience - preferred
• Experience working in a health care system and/or large, academic, or complex health care setting that included payer contracting - preferred
• Hospital, physician group and value-based enterprise financial acumen
• Demonstrated leader of people and manager of resources.
• Demonstrated success in orchestrating, leading, and overseeing negotiations of complex payer contracts in a competitive market including both new and renewals.
• Demonstrated success in overseeing and managing large volumes of high dollar contracts including renewal provisions, day to day compliance and operations, short and long-term projections, and payer relationships.
• Demonstrated knowledge of current federal and NYS regulations regarding managed care contracting, as well as the provision and reimbursement of medical services including, but not limited, to Medicare and Medicaid.
• Proven skills and knowledge relating to the implementation and management of risk-based and other value-based reimbursement models.
• Demonstrated knowledge of the current health care insurance landscape both nationally and locally.
• Demonstrated strategic and System thinker coupled with organizational and critical thinking skills who can consolidate and prepare well researched recommendations and articulate prospective needs.
• Demonstrated analytic capabilities with the ability to consolidate multiple layers of data, identify correlations, prepare effective reports, interpret and/or present information and data using Microsoft/excel and other tools.
• Exemplary interpersonal, verbal, and written communication skills to include the ability to organize, negotiate, resolve conflicts, and build teams.
• Ability to operate independently in high pressure situations and manage people and resources effectively in a quick paced, highly matrixed environment; knows how to collaborate effectively and when to seek guidance from SMEs.
• Proven leadership showing a history of building positive relationships across disparate teams or organizations, influencing decisions positively, showing sound judgment, high energy, prospectivity, flexibility and focus.

Equivalent combination of relevant education and experience may be substituted as appropriate.

Physical Demands

• Standing - Occasionally
• Walking - Occasionally
• Sitting - Constantly
• Lifting - Rarely
• Carrying - Rarely
• Pushing - Rarely
• Pulling - Rarely
• Climbing - Rarely
• Balancing - Rarely
• Stooping - Rarely
• Kneeling - Rarely
• Crouching - Rarely
• Crawling - Rarely
• Reaching - Rarely
• Handling - Occasionally
• Grasping - Occasionally
• Feeling - Rarely
• Talking - Constantly
• Hearing - Constantly
• Repetitive Motions - Frequently
• Eye/Hand/Foot Coordination - Frequently

Working Conditions

• Extreme cold - Rarely
• Extreme heat - Rarely
• Humidity - Rarely
• Wet - Rarely
• Noise - Occasionally
• Hazards - Rarely
• Temperature Change - Rarely
• Atmospheric Conditions - Rarely
• Vibration - Rarely

Thank you for your interest in Albany Medical Center!

Albany Medical Center is an equal opportunity employer.

This role may require access to information considered sensitive to Albany Medical Center, its patients, affiliates, and partners, including but not limited to HIPAA Protected Health Information and other information regulated by Federal and New York State statutes. Workforce members are expected to ensure that:
Access to information is based on a "need to know" and is the minimum necessary to properly perform assigned duties. Use or disclosure shall not exceed the minimum amount of information needed to accomplish an intended purpose. Reasonable efforts, consistent with Albany Medical Center policies and standards, shall be made to ensure that information is adequately protected from unauthorized access and modification.

Thank you for your interest in Albany Medical Center!

Albany Medical is an equal opportunity employer.

This role may require access to information considered sensitive to Albany Medical Center, its patients, affiliates, and partners, including but not limited to HIPAA Protected Health Information and other information regulated by Federal and New York State statutes. Workforce members are expected to ensure that:

Access to information is based on a "need to know" and is the minimum necessary to properly perform assigned duties. Use or disclosure shall not exceed the minimum amount of information needed to accomplish an intended purpose. Reasonable efforts, consistent with Albany Med Center policies and standards, shall be made to ensure that information is adequately protected from unauthorized access and modification.