Director of Payor Contracting

Summary:

The role will be responsible for leading key functions and strategic direction for all Payor contract negotiations, including evaluations of reimbursement models, contract language and the impact of payer strategies on Akron Children's overall strategic plan for Akron Children's Hospital and Akron Children's Health Collaborative (ACHC). This role will also be responsible for directing and overseeing contracting, contract maintenance, and contract management activities, including but not limited to provider enrolment, contract compliance, education, for the hospital, professional services, ancillary, specialty pharmacy, Hemophilia Treatment Center, home health services and all valued based contracts for ACHC. This role will hire, train, coach, counsel, and evaluate performance of any direct reports.

Responsibilities:

1. Responsible for the overall relationship with our contracted payers.
2. Develops and maintains successful & collaborative payor relationships (new and existing) through development and execution of payer agreements that supports Akron Children's and Akron Children's Health Collaborative overall strategic plans.
3. Leads and supports payor negotiations with an emphasis on innovative reimbursement structures to advance the best interest of high quality, affordable, patient care.
4. Negotiates and participates in strategic development of payor contracting initiatives.
5. Implements the contract structures and reimbursement methods and rates for all professional, institutional, ancillary and vendor providers.
6. Works closely and collaboratively with operations team members to ensure key processes are effectively functioning to support contract terms and optimize return on investment.
7. Build collaborative relationships with internal departments in order to address and escalate payer operational issues in order to secure reimbursement.
8. Participates in strategic business development and community efforts and outreach.
9. Leads employees, provides direction, coaches, trains, develops, and manages performance to company goals and expectations.
10. Prepares, manages, and adheres to department budget to maintain expenditure controls.
11. Leads quarterly Joint Operating Committee meetings with our payers to support and build collaborative relationships with our payers and internal clinical teams.
12. Leads monthly payer collaboration calls to address claim and operational issues.
13. Analyzes payer market dynamics, industry trends and competitor strategies to inform contract negotiations and strategic decisions.

Other information:

Technical Expertise

1. Extensive experience negotiating payer contracts with commercial, Medicaid and other insurers.
2. Proven track record of developing and implementing payer strategies that enhance financial performance.
3. Strong understanding of healthcare reimbursement models, including fee-for-service, values-based care, and risk-sharing agreements.
4. Excellent negotiation, communication and interpersonal skills.
5. Ability to analyze complex financial data and make strategic recommendations.
6. In-depth knowledge of regulatory requirements related to payer contracting and compliance.
7. Ability to work collaboratively with internal and external stakeholders.
8. Leadership skills with the ability to inspire and develop teams.

Education and Experience

1. Education: Bachelor's degree in business administration, Healthcare Administration, Finance or related healthcare field is required.
2. Master's degree in Healthcare Administration, Business Administration, or related field preferred.
3. Licensure: N/A
4. Certification: N/A
5. Years of relevant experience: 7 years experience preferred in payer strategy, contracting or healthcare finance.
6. Years of supervisory experience: 3 years is preferred.

Full Time

FTE: 1.000000

Status: Onsite