Payor Relations and Contracting Manager

Description

Summary

Responsible for all aspects of payer relations. Overall goal of, managing payor relationships and contract negotiations to meet the organization's strategies and financial success. Cultivates relationships to assist with problem resolution while positively advocating and removing barriers to access to ensure coverage and reimbursement.

Essential Duties

• Contract negotiations: Lead contract negotiations with payers to secure favorable reimbursement rates and terms for all segments of IBJI. This includes physicians services in office and surgical setting, imaging, rehabilitation and ASC’s. Analyze the potential impact of contract renegotiations by modeling the financial impact.
• Market access strategy development: Contributing to the development and execution of strategies to gain access to payer networks and maximize patient access to services.
• Payer policy analysis: Monitor and analyze payer policies, coverage guidelines and reimbursement methodologies to identify potential challenges and opportunities. Educate leadership, revenue cycle and operations of these challenges and opportunities.
• Quality management: Key knowledge of payor quality measurement tools. Collaborate with internal teams to coordinate strategy and understanding of financial and clinical implications.

Requirements

Job Qualifications

• Bachelor's degree is required, advanced degree is preferred.
• Experience in contract negotiations
• Deep knowledge of healthcare, managed care strategy, pricing and medical reimbursement environment required.
• Proven ability of successfully managing complexity, solving problems and building strong relationships.
• Ability to work well independently as well as collaboratively; self motivated and disciplined to meet deadlines in the context of competing priorities and projects; lead and work effectively with cross-functional teams
• Computer literacy, including high level of competency in Excel