Director, Payer Contracting

2 months ago

Washington, United States The GW Medical Faculty Associates Full time
The Director of Payer Contracting leads and executes the MFA payer contracting strategy, to include Commercial/HMO, Medicare Advantage, and Medicaid, while overseeing the development of new initiatives to enhance payer value and alignment for value-based care programs. The Director, Payer Contracting collaborates with senior leadership regarding business development, healthcare economics and value-based care to analyze contracting strategy and to identify expansion opportunities. The position reports to the Chief Financial Officer.

Responsibilities:

  • Drive creative and alternative pricing and contract structures to ensure value to the payer and profitable for the MFA
  • Lead the MFA payer contracting strategy while actively pursuing and driving the development and execution of profitable agreements
  • Collaborate with payers to reinforce current contract terms and understand claims payment issues
  • Oversee the development of cross-payer contracting strategies to include broker services, health plan marketing, benefit design integration, high-value network offerings, health plan value-reporting and regional, multi-payer initiatives
  • Maximize efficiency and standardization of the payer contracting and pricing process for the MFA by establishing internal contract valuation and reporting methodologies to assess current and future total contract value, and relative risk by line of business
  • Manage value-based care contracting with payers and other risk bearing entities through collaborative partnership with clinical leaders, executive directors, and finance partners
  • Monitor state and federal legislation related to payment initiatives and policy changes that could impact negotiations.
  • Develop proforma models of contracts that show variability in revenue by taking on different types of risk contracts
  • Lead and participate in contract negotiation discussions with health plan prospective customers
  • Assess the impact of arrangements with long-term clients and recommend appropriate changes for updates to renewals
  • Execute and negotiate complex commercial agreements with health plans, evaluate contract economics, and develop creative growth strategies
  • Advise senior leadership and other enterprise-wide stakeholders on payer strategy, positioning, emerging trends, contracting methodologies and risk assessment


Experience and Qualifications:

  • Bachelor's degree in Business, Healthcare Administration, or a related field, and at least 10 years of experience in healthcare, with a focus on the payer market including commercial, Medicare and Medicaid; minimum of 5 years of experience with value based care
  • Solid financial and operational acumen with an understanding of profitability drivers and medical cost trends
  • Deep knowledge of healthcare payer and provider landscape across the relevant markets
  • Ability to execute on growth opportunities across payers and markets, and to adapt contracting strategies as needed
  • Demonstrate solid conceptual, analytical and problem solving skills comfortable operating within actuarial/analytical organization
  • Possess knowledge of best practices in revenue cycle environment


Physical Requirements

  • Must be able to constantly stand, walk, reach outward, and apply manual dexterity in an office setting.
  • Must be able to occasionally lift, carry, push, or pull over 100 lbs. as part of the role.
  • Requires manual dexterity to operate a computer keyboard, calculator, copier machine, and other equipment.


Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)

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