Catholic Health Initiatives Divison Director- Contracting & Payer Relations in WEST DES MOINES, Iowa

Divison Director- Contracting & Payer Relations

Description

Job Summary: The Director, Contracting and Payer Relations is responsible for contract negotiations and payer relations on behalf of Mercy Health Network (MHN). The primary purpose of this role is to negotiate contracts beneficial to MHN through establishing collaborative relationships with customer stakeholders, including payers / insurers, employers, government sponsors, individual consumers, vendors and distribution channel partners.

Accountabilities include achieving MHN contracting and payer relations objectives, including fee for service and value based arrangements, and partnering with ACO / Clinically Integrated Network (CIN) leadership in contracting ACO / CIN networks and services.

Collaboration Relationships:

  • Internal: Collaborates directly with MHN, CHI and TH functional areas, including Health System Leadership, Finance, Payer Strategy, Healthcare Economics, Product Development, Business Development, Business Intelligence and analytics, Revenue Cycle, Performance Management, Physician Practice Management, Clinical Services, MHN & CHI / TH HR and Employee Health Benefits, Legal, Mission and Communications areas.

  • External: Collaborates with key marketplace stakeholders including payers and employers. Develops effective working relationships with payers, employers, ACO / CIN provider entities, MHN affiliates, and affiliated community physicians as necessary.

Essential Position Expectations:

  1. Oversees and manages the Contracting and Payer Relations team.

  2. Responsible for the MHN payer portfolio management, contracting and reimbursement strategy, planning, negotiation, implementation, and analysis of contract performance. Utilizes analysis for contract renewals, renegotiations, or termination recommendation.

  3. Establish, manage, and maintain positive, strategic relationships with payers, employers, product distribution channels and providers as applicable the region.

  4. Develops and implements reimbursement models that maximize reimbursement (including incentive / risk & reward models as necessary), through collaboration with the ACO / CIN and various departments, including clinical, healthcare economics and finance departments.

  5. Develop and establishes the MHN contract standards for contractual agreements, fee for service reimbursement and value based contract structure for MHN and Mercy ACO.

  6. Stays current with managed care and regulatory issues in relation to health benefits, payer activity, contracting and reimbursement methodologies, products and delivery channels including health insurance exchanges, market competition, etc.

  7. Implements and maintains value-based payment and risk arrangements in accordance with MHN and Mercy ACO contract standards & guidelines.

  8. Thought leader regarding the network asset and value creation in terms of affordability, ease of use, and reputation for quality care. Thought leader and subject matter expert regarding insurance operations and insurance.

  9. Collaborates with MHN’s VP of Payer Strategy, Manager of Payment Compliance, finance, and revenue cycle departments to address major collection issues and unfavorable payer practices, including claims denial practices and underpayments.

  10. Coordinates the Contracting Oversight Committee meetings.

Qualifications

Education: Bachelor degree required; Masters in business, healthcare administration, or related field is preferred.

Experience:

  • 5 years progressive managerial and operational healthcare leadership experience.

  • Proven and extensive contracting technical skills, negotiation skills, contract preparation and implementation, financial analysis and rate proposal development.

  • In depth knowledge of various reimbursement methodologies for both fee for service and value based contracts.

Certifications & Licenses: N/A

Job Director/Manager/Supervisor

Primary Location IOWA-WEST DES MOINES-MERCY WEST LAKES

Daily Schedule Days

Scheduled Hours per 2-week Pay Period 80

Weekends Required None

Req ID: 2018-R0181459

We’re an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.