Senior Director-Payor Contracting

Location: WellSpan Health, York, PA

Schedule: Full Time

General Summary

Participates in third party payor contract negotiations and manages contract performance compliance for the System to ensure fair and adequate payment rates, operational terms that are acceptable and manageable, and payor compliance with contract financial and operational terms. Manages and develops support processes for the effective performance monitoring and negotiation of contracts. Leads a team of Payor Contract Negotiators.

Duties and Responsibilities

• Manages all new as well as timely renewals of System contracts, including new hospital additions as applicable, in accordance with System Care Contracting Team. Includes all traditional medical components (hospital, WMG, Apple Hill, rehab/surgery hospital, home infusion, VNA, DME) and Value-Based Purchasing.

• Collaborates with contracting leadership to identify and understand challenging operational issues with payor contract compliance and develops and modifies contracting language to be incorporated into future contracts or contract amendments to minimize operational difficulties. Engages on contract negotiations to ensure operational success and reduction in revenue balances. Collaborates on organizational finance tools, annual budget, and five-year outlooks.

• Collaborates with leadership on identifying opportunities and challenges related to Value-Based Purchasing agreements and revenue opportunities

• Manages the development and maintenance of the System's preferred standard contracting terms to be incorporated into new or revised contracts.

• Manages and develops processes to ensure the System is compliant with contract notification terms, including: annual price increases, change in services, change in sites, etc. Ensures clear and timely communication and updates provided to analytics team.

• Develops and maintains system payor contract summary with key details, including line of business, effective date, end date, termination notice period, COLA/CM date and percentages.

• Develops processes, to collect and maintain available market information regarding market payment rates and methods for various types of managed care payors: including Medicare, Medical Assistance, & Commercial managed care payors.

• Oversees working with appropriate ancillary department personnel in the maintenance and execution of payor contracts (BHU, Rx, Dental, lab, WC).

• Leads the weekly team huddles, monthly team meetings, individual one on one meetings with direct reports, monthly Payor Contracting Update meetings for internal matrix partners.

• Maintains a strong knowledge of all pertinent governmental regulations that pertain to both payor contracts and hospital operations (i.e., Act 68, HIPAA, Surprise Billing) ensuring appropriate compliance requirements are kept by departmental personnel as applicable.

• Assists the VP of Payor Contracting and Population Health in projects, presentations, and negotiation updates.

• Summarizes negotiations (starting point, updates, and final results) for a variety of leadership forums utilizing presentation skills and tools.

• Manages contract terminations, including internal communications and matrix partner collaborations.

• Responsible for the direct leadership and mentorship of Payor Contracting Negotiators.

Travel Requirements:

• Estimated Amount: 10% - Local and regional travels

Qualifications

Minimum Education:

• Bachelors Degree Finance, Healthcare Administration, or related field Required

• Masters Degree Business or Healthcare Administration Preferred

Work Experience:

• 10+ years Experience in Third party payor contracting, Accounting, Patient Accounting, or Government Regulations Required and

• Supervisory experience. Required

• Healthcare reimbursement, third party payor or regulatory experience. Preferred

Knowledge, Skills, and Abilities:

• Excellent computer skills

• Excellent oral and written communication skills

• Data and analytics knowledge

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At WellSpan Health, we are committed to treating all applicants fairly and equitably, regardless of their job classification. If you require assistance or accommodation due to a disability, please reach out to us via email atcareers@wellspan.org. We will evaluate requests for accommodation on a case-by-case basis. Please note that we will only respond to inquiries related to reasonable accommodation from this email address. Rest assured, all requests for assistance or accommodation are handled confidentially, allowing applicants to share their needs openly and honestly with us.

WellSpan Health is an Equal Opportunity Employer. It is the policy and intention of the System to maintain consistent and equal treatment toward applicants and employees of all job classifications without regard to age, sex, race, color, religion, sexual orientation, gender identity, transgender status, national origin, ancestry, veteran status, disability, or any other legally protected characteristic.