Center City, Philadelphia, PA
The Director, Payer Contracting - Managed Care Contracting negotiates and manages a wide array of payer contracts including physician and ancillary services. Provides enterprise with market intelligence as pertains to payer activity, product development, network configuration, profitability, positioning and payment policies. Oversees the analysis and ensures accuracy of these contractual agreements prior to execution.
- Ensures internal and external compliance with all contract provisions, by developing and/or using performance tracking tools (EPSI, Contract Management, etc.) to gauge key performance indicators and aid in revenue cycle recoveries.
- Monitors contract performance regarding financial performance, payment integrity and value based payment programs.
- Manages multiple projects and performs independently under tight deadlines with a focus on effective implementation, clear and consistent communication and follow-up.
- Identifies and creates processes to establish links between Payer Contracting and other departments and develops and documents internal department’s contract requirements.
- Advises the management team on emerging trends and methodologies in managed care contracting, payer relations and legal issues.
- Monitors industry trends, including but not limited to the Affordable Care Act, Healthy PA and/or Medicaid Expansion, anticipates implications and opportunities and collaborates with the Hospital colleagues to develop and manage implementation plans based on contracting activity.
- Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson.
OTHER FUNCTIONS AND COMPETENCIES:
- Maintains contracting calendars and/or a contract dashboard to ensure adherence to key contract dates/timelines related to contract requirements, adjustment and/or renewals.
- Understands and can articulate the business case for and/or against the financial/analytical issues, and administrative implications of contracting recommendations.
- Serves as a subject matter expert and valued business partner for internal departments as assigned regarding managed care matters.
Degree in Health Care Administration, Business Administration, Finance or Accounting
Minimum of 7 years of experience in healthcare administration, including experience in payer contract negotiations.
Extensive knowledge, experience and expertise in managed care contracting negotiations, language, modeling analytics, reimbursement methodologies for hospitals, physicians and ancillary providers, shared shavings and risk contracting, managed care regulations and quality/shared savings program metrics and methodologies.
Must be proficient in Microsoft Word, Excel, Pivot Tables, and PowerPoint. Access skills preferred.
Strong knowledge of industry standard billing codes and health plan operations.
Jefferson Health delivers state of the art healthcare services to patients throughout the Delaware Valley and southern New Jersey. Jefferson (Philadelphia University + Thomas Jefferson University) provides more than 8,400 students from nearly 40 states and 40 countries with 21st century professional education. Combined, we have over 30,000 employees.
Jefferson Health, with 14 hospitals (seven are Magnet designated by the ANCC for nursing excellence) and 40+ outpatient and urgent care locations, offers a broad range of primary and complex, highly specialized care that touches the lives of more than four million patients annually. U.S. News & World Report has ranked Thomas Jefferson University Hospital among the nation’s best in eight specialties. Jefferson Health also includes the NCI designated Sidney Kimmel Cancer Center; it is one of only 70 such centers in the nation.
Thomas Jefferson University has ten colleges and three schools that offer more than 160 undergraduate and graduate programs. Our University is dedicated to inter-professional and transdisciplinary approaches to learning that offer a vibrant and expandable platform for professional education. Through this unique model, we are preparing our students for current and yet to be imagined careers.
As an employer, Jefferson maintains a commitment to provide equal access to employment. Jefferson values diversity and encourages applications from women, members of minority groups, LGBTQ individuals, disabled individuals, and veterans.
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