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Denver Health · 2 weeks ago

Senior Director of Payor Contracting

Denver, CO

Full-time

Onsite

Director/Executive

$203K/yr - $335K/yr

7+ years exp

Denver Health is an integrated, high-quality academic health care system considered a model for the nation. The Senior Director of Payor Contracting is responsible for overseeing and managing the development, negotiation, and implementation of contracts with third-party payers, ensuring compliance with regulations and organizational policies.

Health CareHospitalMedical

Responsibilities

Oversees organizational contract development and management activities and enforce organizational principles of integrity and compliance 10%

Develops standards for contracts, including payment terms, general language and provisions based on strategy discussions, senior management input and organizational needs 10%

Evaluates rate proposals, changes to reimbursement methodologies and conduct related analyses to ensure continued financial viability of the contract 10%

Ensures contracts and proposals are properly entered into organizational databases to measure, track and monitor utilization and financial performance of managed care contracts 10%

Negotiates single case agreements to capture financial reimbursement from non-contracted entities 10%

Serves as primary organizational contact during payer contract negotiations 10%

Assists HPBS Department and internal customers with resolution of complex payer issues. Participate in JOC meetings with third party payers to address contractual payment issues and trends 5%

Communicates and provides tools for contractual terms to other departments whose functions are necessary to the development, implementation and management of the provider arrangements. 5%

Responsible for the credentialing of Denver Health facilities which includes all associated clinics and new business ventures 5%

Maintains knowledge and understanding of healthcare industry trends, standards, and current events relative to provider contracting, network administration and market 5%

Oversees the operation performance of a system-wide, service line-based Charge Review program to identify charge capture and DRG validation improvement opportunities to minimize revenue leakage 5%

Provides data analytics and reporting to HPBS Department to identify potential process improvement in charge capture functions to maximize net reimbursement 5%

Serves as the revenue integrity liaison for HPBS Department and revenue producing departments 5%

Carries out supervisory responsibilities in accordance with the organization’s policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning and directing work; appraising performance; rewarding and performance-managing employees; addressing complaints and resolving problems 5%

Special projects/other duties as assigned by the Chief Strategy Officer or as designated by the Chief Strategy Officer

Qualification

Managed Care contractsContract ManagementReimbursement methodologiesNegotiating skillsHealthcare AdministrationRevenue cycle managementCPTHCPCSICD-11Analytical skillsMicrosoft OfficeLeadership skillsCommunication skillsProblem-solving skills

Required

Bachelor's Degree with concentration in Finance, Accounting, Business, Management, Healthcare Administration related field

7-9 years Contract Management demonstrated experience with large Managed Care systems

1-3 years management experience, preferably in healthcare

Strong knowledge of Managed Care contracts

Advanced understanding of CPT, HCPCS, ICD-11 and various reimbursement methodologies such as Medicare/ Medicaid and third-party billing requirements

Extensive knowledge and experience with Medicare/ Medicaid regulations

Excellent negotiating skills and proficiency in utilizing and interpreting financial models and analysis

Experience with APC reimbursement, CMS rules and regulations, coding and billing compliance

Strong working knowledge of billing and collection processes and functions, charging processes and general revenue cycle management strategies and industry best practices

Requires high attention to detail, analytical and critical thinking, management skills, organization, prioritization and problem resolution

Excellent verbal and written communication, leadership, delegation, collaboration and interpersonal skills

Ability to be resourceful, customer-service oriented and independently problem-solve

Working knowledge of the following information systems to include accessing information, updating, correcting and/ or deleting data. General knowledge related to various software applications and their capabilities. Microsoft Office applications: Word, Excel, Access, PowerPoint, Infor, and Outlook

Preferred

Juris Doctorate

Benefits

Outstanding benefits including up to 27 paid days off per year, immediate retirement plan employer contribution up to 9.5%, and generous medical plans

Free RTD EcoPass (public transportation)

On-site employee fitness center and wellness classes

Childcare discount programs & exclusive perks on large brands, travel, and more

Tuition reimbursement & assistance

Education & development opportunities including career pathways and coaching

Professional clinical advancement program & shared governance

Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program

National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer