Manager of Payor Contracting

CORE RESPONSIBILITIES: 

Contract Negotiations & Support of Overall Strategy 

• Negotiate and contract to optimize reimbursement structures and rates with payor partners, including the facilitation of the approval and signature process. 
• Negotiate language and terms and conditions across all payor contracts, primarily value-based 
• Work directly from guidance of Director of Payor Contracting to support a work plan/strategy 
• Work to support system strategic initiatives, as directed by the Director of Payor Contracting 
• Develop guidelines for best practice items and key contractual acceptable language to support negotiations with a consistent approach where possible 
• Amend existing agreements to find opportunities for coverage of new services or to enhance current contract terms in terms of new language or operational needs  
• Leverage internal BI/RCM data to assure negotiated rates and rate requests maintain our competitive position 
• Stay informed on market trends and healthcare industry shifts to help inform overall payor strategy and successful negotiations 

Outcomes Management & Operational Support 

• Recommend necessary strategies to leadership based on contract performance 
• Work closely with RCM on operational issues related to Payor Contracting - includes attendance at Payor Ops and Joint Operating Committee (JOC) meetings and support to RCM leadership to help monitor financial performance of assigned payor contracts versus expectations  
• Partner with teams directly responsible for validation of payments and/or policy monitoring 
• Identify and develop strategies to mitigate risks and sources of exposure in payor contracts 
• Proactively work with BI and other data teams to refine the reporting of contract performance, analysis, and modeling tools 
• Prepare relevant recommendations and reports for committees and boards, as required 

Stakeholder Support & Engagement 

• Establish and maintain relationships with payors contacts and help facilitate overall relations 
• Provide education on new agreements - via written communication or presentations - that may impact stakeholders.  
• Address leadership data needs resulting from new/modified agreements 
• Work with other internal partners on supporting/leading select system strategies where Contracting can drive specific change or help develop new processes 
• Contribute to communications and education regarding Payor Contracting utilizing tools such as the electronic newsletter, educational sessions, or other appropriate forums as needed 
• Interact with providers to identify payor trends requiring action or escalation 
• Continue to grow knowledge of market trends via conferences, continuing education, etc. 
• Maintains strict confidentiality in alignment with HIPAA (Health Insurance Portability and Accountability) guidelines and InterMed policies.  
• Perform other duties to support the mission, vision and values of InterMed.   

MISSION AND VALUES:  

• Follows InterMed’s mission to provide patient-centered primary care, putting the patient first to deliver high quality, high value care.  
• Provide the highest quality care to our patients with a level of service that exceeds their expectations.  
• Maintain a positive attitude and always treat our patients and each other with dignity and respect.  
• Insist on honesty and integrity from each other and our business partners.  
• Make teamwork a core component of our relationships between physicians, staff, and patients.  
• Embrace change to better serve our patients.  
• Use business practices that feature individual accountability and group responsibility to ensure delivery of high value healthcare.  
• Have fun as we carry out our mission to serve.  

KNOWLEDGE, SKILLS, AND ABILITIES: 

Education: 

• Bachelor's degree required. Preferred areas of study include Healthcare Administration, Business, Finance, or another related field. 

Experience:

• Minimum 3 years of experience in a similar or related role such as managed care/ACO contracting, provider/payor relations, project management, physician organization, hospital organization or health plan. 
• Experience in value-based healthcare strongly preferred 
• Demonstrated experience in negotiating and managing complex payor contracts 
• Proficiency in Microsoft Office suite 
• Strong organizational and time management skills to help prioritize tasks and meet deadlines  
• The ability to build strong relationships with internal/external stakeholders 
• Strong analytical and problem-solving skills 
• The ability to interpret and present operational and financial impacts related to Payor contracts 
• Strong interpersonal, communication (written/verbal) and presentation skills 
• Awareness of relevant healthcare industry trends 

The estimated compensation range is the budgeted amount for this position. Final offers are based on various factors, including skill set, experience, location, qualifications, and other job-related reasons. Certain positions may be eligible for incentive compensation plans above and beyond base compensation.