Manager-Payor Contracting

Duties and Responsibilities

Essential Functions:

• Coordinates and facilitates the maintenance and management of payor relationships on behalf of WellSpan Health by serving as a facilitator to provide management support. Acts as resource for payor contracting personnel. Participates and coordinates learning events and training. Participates in the development and maintenance policies relating to operations of departments. Provides feedback to the Director for the staff's performance evaluations. Provides support of existing payor relationships on all contracts including handling of all operating issues.
• Identifies operational/denial root causes and processes and works collaboratively with other departments to improve processes when control, operational weaknesses and/or compliance issues are found. Leads improvement initiatives utilizing Lean principles to improve operational and/or financial efficiency of System entities.
• Leads and maintains Payor Research Information Request process and the investigation of revenue processes, including billing system errors, to ensure systems are optimizing reimbursement while maintaining compliance with applicable rules and policies.
• Participates in the management of payor relationships, integrating contract changes into appropriate clinical areas and managing payor issues with periodic payor meetings. Attends, either in person or virtually, JOC meetings between Payors and the System.
• Coordinates all System payor policy changes through communication with all applicable departments.
• Develops, completes and maintains System quarterly payor yields (actual vs. expected) for all acute care hospitals.
• Works with Payor Contracting Analysts to maintain payment terms and conditions of Commercial and Government contracts and supports Payor Contracting Analysts in addressing contract-related issues on behalf of internal departments.
• Assists the Director in the collection and maintenance of performance measure information relative to value-based contract payment terms and voluntary pay for performance programs.
• Manages contractual notification requirements as defined by contract language for new service additions to the WellSpan Health delivery system.
• Responsible for facility credentialing/re-credentialing for Summit Health for Commercial, Medicare Advantage Products and PA Medicaid MCOs.
• Participates in interdepartmental meetings (i.e. CCT, UM, RCM Committee) to coordinate improvement in the hospital's revenue cycle.
• Assists the Director of Payor Contracting Operations and VP of Payor Contracting and Population Health in financial analysis and/or other requested projects.

Common Expectations:

• Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest trends in field of expertise.
• Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.