Director, Payer Strategy & Contracting

Director, Payer Strategy And Contracting

Get back to what you need and love to do. The possibilities are endless... Now more than ever, our guiding principles are helping us in our search for exceptional talent - candidates who align with our unique workplace culture and who want to maximize the abundant opportunities for growth and success. If this describes you then let's talk! HSS is consistently among the top-ranked hospitals for orthopedics and rheumatology by U.S. News & World Report. As a recipient of the Magnet Award for Nursing Excellence, HSS was the first hospital in New York City to receive the distinguished designation. Whether you are early in your career or an expert in your field, you will find HSS an innovative, supportive and inclusive environment.

Working with colleagues who love what they do and are deeply committed to our Mission, you too can be part of our transformation across the enterprise.

Emp Status

Regular Full time

Work Shift

Compensation Range

The base pay scale for this position is $112,000.00 - $170,875.00. In addition, this position will be eligible for additional benefits consistent with the role. The salary of the finalist selected for this role will be determined based on various factors, including but not limited to: scope of role, level of experience, education, accomplishments, internal equity, budget, and subject to Fair Market Value evaluation. The hiring range listed is a good faith determination of potential compensation at the time of this job advertisement and may be modified in the future.

What You Will Be Doing

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/translated 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 :

• Experience (7+ years) in payer or provider contracting and/or provider network oversight. Major teaching/surgical hospital experience or health plan experience is highly desirable.
• Experience managing and leading a professional team.
• Experience dealing with payers, patient financial services professionals, providers, and their billing staff.
• Possesses key payer contacts and knowledge of payer contracting.
• Is detail oriented.
• Knowledge of the healthcare industry and payer reimbursement methodologies (both hospital and physician).
• Ability to work independently and collaboratively to solve complex problems.
• The ability to influence and motivate others, as well as work collaboratively within a multi-stakeholder environment is required.
• Excellent verbal and written communication skills.
• Excellent organizational and multi-tasking skills.
• Is professional when dealing with stakeholders. Uses good judgement and takes a thoughtful approach to resolving and communicating issues.

Education:

• Bachelor's degree in health or business administration, economics or related subject is required. Master's preferred.

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.