Director Payer Contract/Ops/Credentialing

Job Summary

Responsible for technical and professional payer contracting and credentialing for the entire Health System. Provides guidance and support to Senior Leadership in aspects of payer contracting/negotiations, pricing, and delegated credentialing for the Health System. Responsible for pivoting and adapting NCHS to an everchanging payer landscape and reimbursement structure. Be a role model and leader to direct reports and develop a strong educated and impactful team bench.

Job Specific Duties

• Responsible for detailed understanding of health care industry, market dynamics, trends, competitors, regulations, and payer environment.
• Collaborates with the management team and all departmental levels on both the hospital and physician sides.  Ensure operational issues are addressed and remedied through negotiation, project planning, or contract modification.
• Creates and maintains professional relationships with payers and potential affiliates.
• Creates, analyzes, and interprets financial reports to support payer negotiations, trends, and audit.
• Implements and communicates contracting strategies in collaboration with  Senior Leader.
• Manages all out of network contracting for both hospital and employed physicians.
• Responsible for the management and development of subordinates.
• Knowledge and willingness to support new contracting strategies and approaches. Innovative and out of box thinker
• Provides direction, feedback, and recommendations on trended payer performance; serves as the SME for all payer related contractual arrangements/issues- current and historical.
• Responsible for overseeing the management of all in network and out of network contracting and negotiations for the hospital and employed physician group.
• Responsible for making high impact decisions steeped in judgment.
• Develop and lead Joint Operating Committee meeting with payers and respective NCHS departments.
• Complies with legal and regulatory compliance requirements.
• Leads and oversees Corporate Credentialing function.

Minimum Job Requirements

• Bachelor's Degree in Business Administration or Health Management
• 7-10 years of management experience in the finance/analytics/accounting field- healthcare related.
• 7-10 years of hospital or payer contracting and negotiating experience.

Knowledge, Skills, and Abilities

• MBA, MHA, and or JD preferred.
• Work well under immense pressure with an ability to focus on multiple priorities while maintaining focus, attention to detail, and connecting all the dots.
• Demonstrated leadership progression.
• Knowledge of Governmental and Commercial payer fee for volume and fee for value reimbursement methods.
• Strong analytical and contract language interpretation skills.
• Familiarity working with Lawyers and interpreting statutes and regulations.
• Business acumen and strong financial skills.
• Excellent written, oral, and communications skills.
• Success in persuasion, influence, and negotiation skills.
• Management expertise, strong knowledge of data analysis, and statistics.
• Able to handle day to day administrative routine, as well as, constantly changing, competing projects, urgent situations, sometimes simultaneously.
• Able to relate cooperatively and constructively with payers and co-workers.
• Effective communicator with a strong, transparent, and clear style; ability to deliver tough messages with tact.
• Effectively monitor and develop the abilities of subordinates.
• Able to maintain confidentiality of sensitive information.
• Knowledge of payer and hospital credentialing function.
• Ability to interpret, adapt, and react calmly under stressful conditions.
• Ability to analyze and interpret complex models and apply to business ask; strong spreadsheet skills.
• Ability to use logical & scientific thinking to interpret technical data and solve a broad range of problems.
• Able to relate cooperatively and constructively with medical staff, executives, staff, elected officials, and managed care companies.
• Independent and self starter with exceptional judgement and time management skills