Director Payer Contract/Credentialing (Managed Care Dept)

Job Description - Director Payer Contract/Credentialing (Managed Care Dept) (27409) • *Remote Candidates Welcome to Apply** Job Summary Responsible for technical and professional payer contracting, credentialing, and pricing for the entire Health System. Provide 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 subordinates 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 value based transformational contracting strategy at the right time in the right setting. • 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 Pricing function. • Leads and oversees Corporate Credentialing function. Qualifications • Bachelor's Degree in Business Administration or Health Management • 4-7 years of management experience in the healthcare finance/payer/managed care contracting field • 7-10 years of hospital and/or payer negotiations and analysis experience Knowledge, Skills, and Abilities • MBA or MHA 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 fee for volume and fee for value reimbursement methods. • Strong contract review and 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. Job: Management Primary Location Department: NCHS-MANAGED CARE CONTRACTING-1000-900910 Apply Job!