Senior Director of Payor Contracting

Job Description:

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, participates in third party payor contract negotiations, manages contract performance compliance and commercial payor value based performance for the System to ensure fair and adequate payment rates, operational terms that are acceptable and manageable, and payor compliance with contract financial and operational terms. Manages and develops support processes for the effective performance monitoring and negotiation of contracts. Leads a team of management level personnel.

Duties and Responsibilities

Essential Accountabilities:

1. Oversees overall payor contract development and implementation throughout the organization.
2. Oversees the external and internal Payor Value Based Programs.
3. Manages all new payor contracts and/or renewals for all WellSpan System contracts. Includes all WellSpan physical health and behavioral health contracts, value-based programs, and minor payor shared savings/risk arrangements.
4. Participates in major risk contract negotiation and implementation
5. Meets internally to understand challenging operational issues with payor contract compliance and develops and modifies contracting language to be incorporated into future contracts or contract amendments to minimize operational difficulties.
6. Manages the development and maintenance of the System’s preferred standard contracting terms to be incorporated into new or revised contracts.
7. Reviews, updates, coordinates, and provides guidance to formulate policies and procedures regarding payor contract-related activities within operational processes.
8. Manages and develops processes to ensure the System is in compliance with contract notification terms, including, but not limited to, annual price increases, change in services, change in sites, acquisitions, new services or programs for all physician health and behavioral health entities of the System.
9. Oversees processes, to collect and maintain available market information regarding market payment rates and methods for various types of managed care payors: including Medicare, Medical Assistance, & Commercial managed care payors.
10. Oversees the development of education and training processes for the System entities regarding payor contracting related activities.
11. Ensures mechanisms are in place to disseminate information regarding payor contract changes that can affect reimbursement or charging, documentation, or procedures throughout the system.
12. Coordinates any contract changes and new contracts, with legal counsel, in accordance with the protocol established by the organization.
13. Leads the ad hoc Care Contracting Team meetings, coordinating payor policy changes and operational issues with the Director-Payor Contracting Operations.
14. Responsible for the leadership and mentorship of the negotiation management team and the executive administrator

Qualifications

• Minimum Experience:
  • Minimum 10 years
• Minimum Education:
  • Bachelor's Degree
• Minimum Field Of Expertise:
  • Third party payor contracting, Accounting, Patient Accounting, Government Regulations,
• Preferred Experience:
  • Preferred Experience: Healthcare reimbursement, third party payor or regulatory experience
• Preferred Education:
  • Master's Degree
• Notes:
  • Other combinations of formal education, training and experience may be considered.

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