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Director Payor Contracting
4 months ago
Summary
SUMMARY OF THE JOB
Under general direction of the CFO, this position provides leadership and coordination of Deaconess Illinois’ managed care contracting function. The incumbent is responsible for continued development of contractual relationships and their ongoing retention in conjunction with the Contract Negotiation Team. These contractual relationships are critical to the financial health of Deaconess Illinois. The incumbent serves in a leadership role in addressing a wide, complex spectrum of critical management issues, and must be innovative in developing new structures and reimbursement methods to retain existing contracted relationships, and to respond effectively to new health insurance entities and products entering the market. The typical contract structure requires the incumbent to consider a wide range of elements and terms in order to resolve the conflicting objectives of market competitive rates and institutional financial viability. In performing the role, this position:
Provides oversight or direct negotiating in all Managed Care negotiation and contracting activities consistent with the Managed Care strategies, business and financial plans. Negotiates contracts with Managed Care payers and governmental entities on behalf of all fully owned entities within the Health System, including legal language review, proposal of rates, reimbursement methodologies, and review of any state or federal regulations. Directs and provides financial analysis to support contracting efforts and issue resolution to include the use of PIC forecaster Models, Excel Models and other tools available to assess contracts or revenue recovery opportunities. Analyzes and monitors financial and operational aspects of existing Managed Care Contracts for use in making recommendations on renewals, re-negotiations or terminations. Cultivates and maintains professional relationships with all third parties and/or vendors to promote proactive problem resolution. Researches state and federal regulations as they change for payers and educates internal departments and facilities on the impacts of these changes to reimbursement and processes. Manages the implementation of completed contracts including dissemination of the contract to relevant parties, explanations of new items in the contract, ensures contract has been scanned, filed and logged into _______. Maintains an open flow of communication with Government Relations (lobbyists) on issues affecting healthcare providers and facilities. Coaches and mentors leaders within the organization at all times.