Duties and Responsibilities

Essential Functions:

• Supports professional and collaborative relationships with Payors and team members.
• Manages active contract negotiation processes to ensure System contracting terms are adequately addressed, and the administrative process is controlled effectively on behalf of the Health System.
• Manages assigned payor book of business including, but not limited to, Commercial, Medicare Advantage, Medicaid for both PA and MD based providers.
• In conjunction with Business Manager and operational staff, analyzes financial impact of contract reimbursement, policy, or language changes/initiatives. Negotiates with payors to resolve via rate or language updates.
• In conjunction with Director of Payor Contracting, assures that proposed, new and/or changed contractual programs are attainable within the organization, the contract language accurately memorializes the agreed upon terms and appropriate WellSpan Health personnel is educated on the new or changed programs.
• Maintains knowledge of industry accepted contractual arrangements, financial opportunities, operational challenges, and other payor initiatives, including but not limited to State and Federal MCO regulatory programs.
• Participates in the strategic improvement of payor contracts as part of the Contract Integration Team and at times with Chief Clinical Directors, Directors of Quality, Administrative Vice Presidents, Quality and Clinical Improvement Managers, Ancillary and Hospital Leadership and Payors.
• Monitors and maintains knowledge regarding market activities and changes related to health insurance plans, programs, and regulations.
• Researches and reports on specific requests, as assigned.
• Participates in annual education, committees, and educational offerings.
• Participates, and in some cases, manages WellSpan Health’s third-party facility, ancillary, behavioral health, hospice, and dental payor contract negotiations to ensure fair/adequate payment rates & methodology, and acceptable and manageable operational terms as well as, memorializing such terms into the written payor agreement.
• Works independently and exercises independent judgment and discretion.

Common Expectations:

• Continuously assesses Payor performance. Maintains appropriate quality control/assessment programs (if applicable).
• Enhances professional growth and development through participation in educational programs, current literature in-service meetings, and workshops.
• Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation. Works well in teams.
• Participates in and continuously assesses and improves the department/service line/entity/System’s performance.
• Presents strong negotiation and presentation skills.

Travel Requirements:

• Estimated Amount: 10% - Local and regional travel