Director of Payer and Provider Contracting

3 months ago

Buffalo, United States Great Lakes Integrated Network, Inc. Full time
Job DescriptionJob Description

The Director of Payer and Provider Contracting is responsible for developing, strategizing, and negotiating contracts with health plans for all lines of business and related product lines, as well as designing partnership opportunities to grow and develop GLIN’s high-performing, clinically-integrated network of providers.

Duties and Responsibilities (including but not limited to)

  • Contract Negotiation:
    • Lead the negotiation process for payer contracts, including fee-for-service, value-based, and alternative payment models.
    • Negotiate provider contracts to ensure alignment with payer agreements and IPA objectives.
    • Develop negotiation strategies to optimize reimbursement rates and contract terms.
  • Contract Development and Management:
    • Develop contractual agreements with payers and providers, ensuring compliance with regulatory requirements and ACO policies.
    • Collaborate with legal and compliance teams to review, finalize, and execute contracts.
    • Monitor contract performance and compliance, identifying opportunities for improvement or renegotiation.
    • Ensure overall compliance for network management processes including oversight and management of the provider network, provider rosters, and payer and provider data elements.
  • Relationship Management:
    • Cultivate and maintain strong relationships with payer organizations, including health insurance companies, government payers, and other stakeholders.
    • Collaborate with internal departments, including finance, analytics, operations, legal, compliance, and clinical teams, to align contracting strategies with organizational goals.
    • Serve as the primary point of contact for payer and provider inquiries, escalations, and dispute resolution.
  • Market Analysis and Strategy:
    • Conduct market analysis to identify payer and provider trends, competitive landscape, and opportunities for partnership.
    • Develop strategic initiatives to expand the IPA's network, increase market share, and improve financial performance.
    • Monitor industry changes and regulatory developments to inform contracting strategies and risk mitigation.
  • Performance Evaluation and Reporting:
    • Evaluate contract performance metrics, including reimbursement rates, utilization, and quality outcomes.
    • Prepare and present reports on contract performance to executive leadership and relevant stakeholders.
    • Recommend adjustments to contracting strategies based on performance analysis and market dynamics.
  • Other duties as assigned

Qualifications or Education, Training, and Experience

  • Education: Baccalaureate degree in business, economics, finance, or related field
  • Minimum of 5 years’ experience in healthcare contracting/analytics/network management
  • Minimum of 2 years’ experience managing people, teams, and processes

Knowledge and Skills:

  • An understanding and application of medical billing and reimbursement procedures/practices
  • An understanding of proper negotiation techniques
  • Excellent communication skills, including presentation of complex topics, written and oral communication skills
  • Strategic mindset, with the ability to develop and execute contracting strategies aligned with organizational objectives
  • Ability to work independently in a fast-paced environment
  • Ability to interact with management personnel and the provider community
  • Possess strong organizational skills and attention to detail
  • Ability to multi-task and meet multiple deadlines
  • Adaptive and flexible to new ideas and change
  • Strong supervisory and leadership skills
  • Excellent interpersonal and negotiation skills
  • Strong analytical and problem-solving skills
  • Ability to adapt to the needs of the organization and employees
  • Proven ability to prioritize tasks and to delegate them when appropriate
  • Proficient with Microsoft Office Suite or related software

*This is a hybrid-remote position and candidates must reside in WNY to be considered.

We offer an outstanding benefits package including health, dental, 401K, vacation, and PTO, as well as a great working environment

Pay range: $110,000. to $160,000.

The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within job’s compensation range, and will be determined by considering factors including, but not limited to market data, education, experience, qualifications, and expertise of the individual and internal equity considerations

Equal Employment

Our culture encourages individual development, embraces an inclusive environment, rewards innovative excellence, and leads New York in provider and patient satisfaction. Great Lakes Integrated Network (GLIN) values diversity, inclusion, and equity as matters of fairness and effectiveness. We are committed to hiring and retaining a staff that reflects the diversity of the communities we serve, fostering an inclusive working environment where staff of all backgrounds feel welcomed and engaged.

Great Lakes Integrated Network is an Equal Opportunity Employer

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