Director, Payer Strategy & Contracting

Director, Payer Strategy and Contracting

Reporting directly to the Assistant Vice President, Payer Strategy and Contracting, the Director of Payer Strategy and Contracting will be primarily responsible for the negotiation, implementation and oversight of payer contracts and relationships. The Director will work closely with the analytics team to model all contract proposals including fee-for-service and value-based arrangements (i.e., shared savings, bundles, etc.). They will work closely with the contract operations team to troubleshoot contract operational issues and assist where necessary to bring them to resolution using their understanding of the underlying contracts as well as by leveraging their payer relationships.

Responsibilities :

• Meets with organizational leadership and stakeholders to ascertain and develop strategic payer contracting goals.
• Negotiates contracts ensuring financial and strategic goals are translated into contractual language accordingly.
• Analyzes payer contract proposals in conjunction with the analytics team to ensure contracts meet financial goals.
• Works closely with the legal team to review and edit contracts as appropriate.
• Ensures internal stakeholders are aware of contract terms, reimbursement rates, and payer policies and that contract terms are appropriately communicated into front and back-end processes.
• Works closely with the revenue cycle teams to ensure contracts are loaded appropriately into billing and decision support systems.
• Works closely with the contract operations team, UM / clinical denials team, and revenue cycle teams to identify trends and opportunities in outstanding accounts receivable.
• Escalates issues as necessary to payer contacts for resolution. In conjunction with contract operations, recommends escalation through senior management as appropriate.
• Identifies trends / patterned issues to aid in contract renegotiations.
• Assesses contract administrative terms and advises leadership accordingly on measures of contract performance.
• Maintains up to date knowledge on the healthcare market, specifically in regard to payer policies and reimbursement trends.
• Possesses strong leadership skills and demonstrates capability to inspire staff to pursue excellence in goals and productivity; capable of coaching and improving staff in need of professional development. Places high priority on overall team performance.
• Additional responsibilities as required to accomplish departmental goals.

Experience, Competencies, and Personal Characteristics :

Education :

Non-Discrimination Policy : Hospital for Special Surgery is committed to providing high quality care and skilled, compassionate, reliable service to our community in a safe and healing environment. Consistent with this commitment, Hospital for Special Surgery provides care, admits, and treats patients and provides all services without regard to age, race, color, creed, ethnicity, religion, national origin, culture, language, physical or mental disability, socioeconomic status, veteran or military status, marital status, sex, sexual orientation, gender identity or expression, or any other basis prohibited by federal, state, or local law or by accreditation standards.