Contracting and Payer Relations Director

2 weeks ago


Dover, Delaware, United States Bayhealth Hospital Kent Campus Full time
Job Title: Executive Director of Contracting and Payer Relations

Job Specialty: Management

Job Duration: Permanent Position

Shift: Days, Full Time

Guaranteed Hours: 80 Hours

Experience: Minimum 10 years of contract negotiation with Managed Care Organizations

License: None Required

Certifications: Preferred Certification related to the position, if applicable

Must-Have: Master's Degree in Business Administration

Job Description:

As the Executive Director of Contracting and Payer Relations at Bayhealth Hospital Kent Campus, you will be responsible for leading all aspects of managed care, governmental, value-based, and population health/clinical initiatives.

You will develop and improve relationships with third-party payers, ensuring reimbursement rates are robust and third-party payers abide by contract terms.

You will collaborate with other Revenue Cycle leaders and key stakeholders to negotiate agreements with third-party payers to align with strategic goals.

You will generate reports outlining successes and opportunities in the revenue cycle and meet with leadership of local plans to discuss strategic opportunities and improvements.

You will recommend managed care contracting strategy to the CFO and serve as the primary liaison with third-party payers.

You will foster effective collaboration between departments for a consistent approach to managed care requirements and work with the Denials Department to create effective appeals.

You will conduct regular meetings with third-party payers to improve payment processes and claim follow-up and represent the organization in state-wide meetings and participate with regional committees.

You will be accountable for the overall success of the managed care program and maintain the contract management system.

You will ensure annual payment adjustments are accurate and complete, create price transparency machine-readable files annually, and serve on utilization review, level of care, and readmission committees.

You will negotiate single-case agreements as required and provide input on charge master development and adjustments.

You will execute all other duties as assigned within the job scope and responsibilities.



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