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Director Payer Contract/Credentialing

3 months ago

Miami, Florida, United States Nicklaus Children's Hospital Full time
Description

**Remote Candidates Welcome to Apply**

Job Summary

Responsible for technical and professional payer contracting, credentialing, and pricing for the entire Health System. Provide guidance and support to Senior Leadership in aspects of payer contracting/negotiations, pricing, and delegated credentialing for the Health System. Responsible for pivoting and adapting NCHS to an everchanging payer landscape and reimbursement structure. Be a role model and leader to subordinates and develop a strong educated and impactful team bench.

Job Specific Duties

  • Responsible for detailed understanding of health care industry, market dynamics, trends, competitors, regulations, and payer environment.
  • Collaborates with the management team and all departmental levels on both the hospital and physician sides. Ensure operational issues are addressed and remedied through negotiation, project planning, or contract modification.
  • Creates and maintains professional relationships with payers and potential affiliates.
  • Creates, analyzes, and interprets financial reports to support payer negotiations, trends, and audit.
  • Implements and communicates contracting strategies in collaboration with Senior Leader.
  • Manages all out of network contracting for both hospital and employed physicians.
  • Responsible for the management and development of subordinates.
  • Knowledge and willingness to support new value based transformational contracting strategy at the right time in the right setting.
  • Provides direction, feedback, and recommendations on trended payer performance; serves as the SME for all payer related contractual arrangements/issues- current and historical.
  • Responsible for overseeing the management of all in network and out of network contracting and negotiations for the hospital and employed physician group.
  • Responsible for making high impact decisions steeped in judgment.
  • Develop and lead Joint Operating Committee meeting with payers and respective NCHS departments.
  • Complies with legal and regulatory compliance requirements.
  • Leads and oversees Corporate Pricing function.
  • Leads and oversees Corporate Credentialing function.
Qualifications

Minimum Job Requirements

  • Bachelor's Degree in Business Administration or Health Management
  • 4-7 years of management experience in the healthcare finance/payer/managed care contracting field
  • 7-10 years of hospital and/or payer negotiations and analysis experience

Knowledge, Skills, and Abilities

  • MBA or MHA preferred.
  • Work well under immense pressure with an ability to focus on multiple priorities while maintaining focus, attention to detail, and connecting all the dots.
  • Demonstrated leadership progression.
  • Knowledge of fee for volume and fee for value reimbursement methods.
  • Strong contract review and interpretation skills.
  • Familiarity working with Lawyers and interpreting statutes and regulations.
  • Business acumen and strong financial skills.
  • Excellent written, oral, and communications skills.
  • Success in persuasion, influence, and negotiation skills.
  • Management expertise, strong knowledge of data analysis, and statistics.
  • Able to handle day to day administrative routine, as well as, constantly changing, competing projects, urgent situations, sometimes simultaneously.
  • Able to relate cooperatively and constructively with payers and co-workers.
  • Effective communicator with a strong, transparent, and clear style; ability to deliver tough messages with tact.
  • Effectively monitor and develop the abilities of subordinates.
  • Able to maintain confidentiality of sensitive information.
  • Knowledge of payer and hospital credentialing function.
  • Ability to interpret, adapt, and react calmly under stressful conditions.
  • Ability to analyze and interpret complex models and apply to business ask; strong spreadsheet skills.
  • Ability to use logical & scientific thinking to interpret technical data and solve a broad range of problems.
  • Able to relate cooperatively and constructively with medical staff, executives, staff, elected officials, and managed care companies.

Job : Management

Primary Location : Florida-Miami-NCHS Corporate Headquarters

Department : NCHS-MANAGED CARE CONTRACTING

Job Status
:Full Time