Develop and manage a portfolio of payor contracts that optimize organization revenue and margin

Develop and implement the strategic plan for payor negotiations

Negotiate reimbursement rates and payment related terms with both new and existing payors effectively, with a focus

on improving reimbursement rates and terms that maximizes enterprise revenues with local, regional, and national

payors

Establish and maintain positive, appropriate relationship with market payors both locally and regionally

Coordinate financial analysis of payor contract performance and modeling projections based on alternate contract

agreements with payors, adverse trends, etc, and make appropriate recommendations or conclusions

Develop and execute effective communication plans with both internal and external stakeholders related to payor

relationships, negotiations, organizational contractual obligations, and development in the managed care marketplace

Identify and capitalize on value-based reimbursement opportunities that strengthen payer partnerships and patient

volumes.

Contract Negotiation: Leading negotiations with payors to secure favorable terms and

conditions for the organization inclusive of understanding the financial and operational

impacts of contract terms.

· Relationship Management: Building and maintaining strong relationships with payors to

ensure ongoing collaboration and problem-solving.

· Compliance and Regulatory Adherence: Ensuring all contracts comply with relevant laws

and regulations, and staying updated on changes in healthcare policies.

· Financial Analysis: Analyzing financial data to assess the impact of contracts on the

organization’s revenue and profitability.

· Strategic Planning: Developing and implementing strategies to optimize payor contracts

and improve reimbursement rates.

· Performance Monitoring: Tracking and reporting on the performance of payor contracts, identifying areas for improvement.

Education

Bachelor of Science in Healthcare Administration, Business or similar discipline required; MBA prefered

Minimum Work Experience

· 7 - 10 years previous experience working in a payer and or provider contracting or reimbursement environment. · Minimum 5 years in a leadership capacity.

Required Skills, Knowledge, and Abilities

· Highly developed communication and organizational skills

· Significant knowledge of contractual, administrative, health insurance and operational issues related to managed care organizations, hospitals, physician groups, and health insurance benefit plan designs

· Proven and extensive contracting technical skills; negotiation skills, contract preparation and implementation, financial analysis, and rate proposal development, and in-depth knowledge of various reimbursement methodologies

· Experience with Fee for Service, Risk and Value Based Contracts for Commercial, Medicare Advantage, Medicaid, and Exchange products..