Job Description

OPPORTUNITY SUMMARY & RESPONSIBILITES

Director of Commercial Payor Management is responsible for analyzing, developing, reviewing, auditing and negotiating existing and new relationship payor with commercial health insurance companies, thru in-network, out-of-network, and 3rd party network structures. For new relationships, the position leads the entire process, from the analytical evaluation of the best strategy that maximizes the revenue per billed service for the company while also balancing the impact of patient volume changes due to the relationship. For relationships both new and existing that result in some form of a contract, the Director leads the company through the entire contractual process, from pre-contract through post-signature phases, including monitoring and managing performance of the contract. For all commercial relationships, contractual or non-contractual, this position closely collaborates with executive leaders, operations and surgeons to ensure all are engaged, informed and aligned with the strategy and results of new relationships and any changes to existing relationships.

Key Responsibilities:

• Establishes professional relationships with all commercial payors who are in the top 8 payors of all company surgeons payor mix as measured by a percentage of net revenues.
• Analyze, negotiate and manage assigned contracts, including initiate, analyze, plan, finalize, implement, report (written and verbal) and direct related negotiations.
• Proposes contracting and pricing models and strategies using knowledge of market, local and national benchmarks, and payer market. Leader of negotiating team for company.
• Presents analysis, strategy, and recommendation in a clear and concise method (email, Excel, and/or PowerPoint) to - depending on the circumstances - CEO, CFO, others leaders of the company's Revenue Cycle Management team, surgeons, and/or office managers.
• Negotiates contract language across all contracts, striving for uniformity among different contracts, partnering with Executive leaders as needed and as appropriate.
• Coordinates finance, legal and operational reviews of contracts. Coordinates sign off on all proposed terms of contracts and amendments, adhering to Company contract sign off and approval processes.
• Adheres to all Company processes for tracking rates and terms of all contracts.
• Is a valuable member of the team based on core business subject matter expertise, general industry knowledge and skills and interest in being a member of a team. Consults with other members of the Leadership Team on contract terms and updates to contracts that may apply to operational areas.
• Has the authority to direct and support managers with functional area responsibilities.

Required Qualifications:

• Bachelor’s degree or equivalent required
• Minimum of 5 years of experience revenue cycle, including payor contracts
• Minimum of 3 years of relevant experience with physician, dental, physician, clinical, or health system contracting required.
• Strong demonstrated knowledge and understanding of healthcare industry, legal and regulatory requirements.
• Assure contractual arrangements meet financial targets and legal/regulatory compliance requirements.
• Strong analytic, negotiation and presentation skills.
• Develop and maintain periodic, e.g., bi-weekly, reports on the status of all contracts.
• Assure accurate data entry of contract specifications and terms into database and completeness of all contracting processes.
• Advanced skills with Microsoft applications which may include Excel and PowerPoint
• Maintain excellent written and verbal communication with all internal and external customers.
• Ability to multi-task, pay close attention to detail and be flexible in a fast paced and growing organization.
• Strong organizational and analytical skills.

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