Director, Medical Data Contracting

1 month ago


Morgantown, West Virginia, United States WVU Medicine Full time
Job Summary

This role is responsible for leading the development and implementation of managed care contracting strategies for WVU Medicine. The ideal candidate will have a strong background in healthcare contracting, negotiation, and leadership.

Key Responsibilities
  • Develop and implement managed care contracting strategies to achieve organizational goals
  • Negotiate contracts with payers, including HMOs and other types of payer agreements
  • Lead interdepartmental teams to operationalize contract terms and payer policies and procedures
  • Manage and analyze contract compliance, including review of payer performance trends and resolution of major payment disputes
  • Develop and maintain relationships with payers, including negotiation of non-risk agreements for physician and hospital services
Requirements
  • Seven years of progressive experience in healthcare management, including payer contract strategy and negotiations
  • Strong leadership and relationship management skills, with ability to work collaboratively with multiple disciplines internal and external to the organization
  • Superior skills in verbal and written communications, organization, decision making, and ability to manage multiple tasks concurrently
  • Knowledge of West Virginia, Ohio, Pennsylvania, Virginia, and Maryland law related to managed care contracting and operations
Preferred Qualifications
  • Experience with contract issues, including indemnification/hold harmless, balance billing, billing and payment terms, and 'medical necessity' issues
  • Understanding of roles of IPAs/PHOs in contracting, including basic understanding of antitrust issues as they relate to risk and non-risk contracts
  • General knowledge of Health Care Financing Authority limitations on physician and hospital Medicare Risk/Choice contracts


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