Be an early applicantLess than 25 applicants

Company

CommonSpirit Health · 1 day ago

System Director Payer Strategy

Phoenix, AZ

Full-time

Remote

Director/Executive

$72.03/hr - $104.45/hr

7+ years exp

Maximize your interview chances

Health CareMedical

Insider Connection @CommonSpirit Health

Discover valuable connections within the company who might provide insights and potential referrals.
Get 3x more responses when you reach out via email instead of LinkedIn.

Responsibilities

Leads in the development of National Payer strategy, relationships, and contracts with assigned National Payers to further drive a clear and effective negotiation strategy, reimbursement structure, contract renewal planning process, and contract implementation in order to achieve the budgeted and forecasted performance and growth requirements as set forth by National and Regional senior leaders.

Gathers information and drafts negotiation goal alignment with Regional senior ministry leaders relative to the strategic, operational, and financial needs and expectations of each Region impacted by the National Payer. Establishes, builds, and maintains positive, strategic interactions and relationships with assigned National Payer(s), employers, providers, and leaders across the ministry.

Documents ‘Lessons Learned’ session following each renewal with their assigned National Payer with the PSR and PAE teams involved in the negotiations to document successes as well as opportunities for improvement for future renewals.

Engages consistently in effective communication with internal stakeholders across the ministry to ensure key contract terms and requirements are successfully implemented to ensure optimal contract performance and revenue expectations. Develops and executes communication plans to internal and external stakeholders related to payer relationships, negotiations, organizational contractual obligations, and developments in the managed care marketplace.

Works intimately with internal analytics teams. Analyzes and monitors financial aspects of existing managed care contracts and rate structure opportunities. Gathers feedback from ministry leaders on financial, revenue cycle, and operational issues with the National Payer related to contract renewals, renegotiations, payer compliance, or termination scenarios, and leverages this feedback to make recommendations regarding participation or nonparticipation with new or existing agreements and networks.

Makes independent decisions and/or exercises sound judgment based upon appropriate information and objectives. Comprehends and maintains highly detailed information. Accepts and carries out responsibility for direction, control, and planning.

Leads and organizes the dispute resolution process with their assigned National Payer when issues materiality exceed $1M.

Leads and organizes sub-projects necessary to support the National Payer negotiation; keeps detailed work plans, and actively tracks the status of open items, following up consistently to ensure deadlines are achieved. Stays current with emerging payer trends, new reimbursement methodologies, regulatory issues, plan benefits, payer activity, products and delivery channels including health insurance exchanges and market competition.

Participates in establishing the composition, pricing, and management of fee and value-based payment and risk arrangements with National Payers in support of CommonSpirit Health’s Healthier Communities strategy. Develops, implements, and maintains value-based payment and risk arrangements in conjunction with national standards & guidelines. Supports the strategic objectives of CommonSpirit Health’s IDNs, population health, and care management initiatives through directly engaging National Payers and employer customers, including CSH employee health benefits.

Participates in and contributes to CommonSpirit Health’s PSR knowledge base through sharing best practices, developing contract performance goals, key metrics, network development, reimbursement and language guidelines, revenue realization, and other applicable work streams.

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Negotiation with payersCapitation experienceManaged care contractingHealthcare leadershipPayer strategyFinancial analysisStrategic relationships

Required

Bachelor’s Degree – equivalent education and experience in payer strategy, managed care or provider network senior level role may be considered in lieu of degree.

Minimum of seven (7) years’ progressive leadership experience in the healthcare environment, of which five (5) years are in managed care contracting for a hospital, healthcare system, or health plans in an intensive managed care market.

Have proven experience negotiating with large payers and full life cycle experience negotiating hospital/physician and ancillary agreements. Must have all three.

Must have capitation experience and knowledge.

Ability to establish, build, and maintain positive, strategic interactions and relationships with leaders across the ministry as well as with external and internal PSR relationships, providers and departments.

Ability to identify opportunities and take action to build relationships between one’s area and other areas, teams, departments, or organizations to help achieve business goals.

Ability to draft proposal letters, recommendations, payer outlines, presentations and offers suggestions and ideas to move the negotiations forward.

Team leadership and/or supervisory experience in healthcare or financial setting.

Ability to creatively problem solve, and to achieve the operational and financial goals of both PSR and the broader organization.

Ability to provide feedback on and understand regulations and communicating proactively regarding regulations.

Preferred

Experience with West Coast Payer negotiation.

Company

CommonSpirit Health

Glassdoor

3.6

Common Spirit Health is a healthcare organization that provides research programs, home health programs, and virtual care services. It is a sub-organization of CommonSpirit Health.

Founded in 2019

Chicago, Illinois, USA

10,001+ employees