Manager-Payor Contracting Operations

York, PA | Professional | Tracking Code: 50520

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General Summary:

Under the general direction of the Vice President-Finance-Population Health & Payor Contracting, and in conjunction with objectives set by the Senior Vice-President Finance and System Care Contracting Team, is responsible for all aspects of maintaining and managing payor relationships on behalf of WellSpan Health, as well as managing operational aspects of quality pay for performance contracts. Responsible for operational management of the WellSpan System contracts, which includes supporting other functional areas that deal directly with payors. Oversees the Payor Contracting Analysts. In helping to accomplish strategic goals, this position is a member of the WellSpan’s System Care Contracting Team as well as participates in a variety of financial projects.

Duties and Responsibilities:

   1   Selects staff, trains/orients personnel, evaluates performance, prepares work schedules and makes recommendations for personnel actions.

   2   Manages existing payor relationships on all contracts including handling of all operating issues related to patient and administration concerns while identifying root causes and process improvement initiatives.

   3   Manages payor relationships, integrating contract changes into appropriate clinical areas and managing payor issues with periodic payor meetings.

   4   Tracks quality/pay for performance programs (e.g. Highmark quality programs) for the WellSpan System.

   5   Manages all Wellspan System payor policy changes through communication with all applicable departments.

   6   Manages contractual notification requirements as defined by contract language for new service additions to the WellSpan Health delivery system.

   7   Maintains a strong knowledge of all pertinent governmental regulations that pertain to both payor contracts and hospital operations (i.e. Act 68, HIPAA) ensuring appropriate compliance requirements are kept by departmental personnel as applicable

   8   Participates in interdepartmental meetings (i.e. CCT, UM, RCM Committee) to coordinate improvement in the hospital's revenue cycle.

   9   Looks for ways to improve operational and/or financial efficiency of the hospital resulting in financial savings.

10   Assists the VP of Payor Contracting and Population Health in financial analysis and/or other projects

 

 

Required Skills

 

 

Bachelor's Degree

Ideally candidate has experience:

Handling health care billing or worked in insurance, dealt with providers from pay relations perspective.

Ability to resolve conflicts between parties

 

 

 

 

 

 

Required Experience

5 years Third party Payor contracting, Accounting, Patient Accounting, Government Regulations, 

Must have 3-5 years  Supervisory Experience

 


About WellSpan
Quality of Life

WellSpan Health is an integrated health system that serves the communities of central Pennsylvania and northern Maryland. The organization is comprised of a multispecialty medical group of more than 1,200 physicians and advanced practice clinicians, a regional behavioral health organization, a home care organization, six respected hospitals, more than 15,000 employees, and 140 patient care locations. WellSpan is a charitable, mission-driven organization, committed to exceptional care for all, lifelong wellness and healthy communities. We are committed to transforming the health of the communities we serve and to educating the next generation of clinicians, staff and leaders.

Quality of Life
Quality of Life

Founded in 1741, the city of York is considered by many as the first capital of the United States. The Articles of Confederation were signed by the Second Continental Congress here in 1777. Its beautifully restored historic district is an architectural treasure. While York retains its farming and manufacturing heritage, at its heart York is a thriving cultural community that has attracted creative talent and innovative entrepreneurial investors from across the nation.

Life in York County offers affordable housing, options for higher education, a thriving arts and cultural community, historical attractions, parks and recreational resources, semi-professional baseball team, fine dining and more — within an easy drive of major East Coast cities.

York County residents can find local employment in healthcare, manufacturing, technology, agricultural and service sectors. (Patient population: 445,000)

Equal Opportunity Employment

WellSpan Health is an equal opportunity employer. Employment selection and related decisions are made without regard to sex, race, age, disability, religion, national origin, color or any other protected class. WellSpan Health does, however, have a tobacco-free/nicotine-free hiring policy.

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