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Manager - Payor Contracting
EvergreenHealth is looking for a Manager of Payor Contracting working full-time in our Contract Management department located in Kirkland, Washington.
EvergreenHealth is an integrated two-hospital healthcare system offering a breadth of services and programs that is among the most comprehensive in the region. Formed in 1972 as a public hospital district, we now serve nearly 850,000 residents of our service area in north King and south Snohomish counties, with medical facilities located throughout the area for easy access. EvergreenHealth has been recognized with many honors and awards, including recognition by Healthgrades as one of America's 100 Best Hospitals (2019).
Responsible as the primary contact at EvergreenHealth for maintaining contractual relationships with payers and health plans. Facilitates all payer contracting activities, including contract review, negotiation of terms, and strategic positioning under the direction of the Director of Payer, Employer and D2B Initiatives. Responsible for the maintenance of managed care plan operating policies and systems; developing effective relationships with payers and providers related to those managed care plans; coordinating the analysis, reporting and negotiation of payer contracts.
•Develops payer contracting strategy and facilitates the negotiation of contract terms and rates with health plans and payers.
•Works with the managed care analyst team to assess and respond to payment proposals and to develop modeling analysis tools.
•Responsible as primary lead for organization in communications to payers for contract negotiations
•Monitors, analyzes and reports on the state of the payer industry via report cards and other assessments.
•Assists with the negotiation and monitoring of contract performance of value-based contracts with payers, including the success of meeting financial and quality targets
•Works closely with the Revenue Cycle team (Admitting, Medical Records, Business Office, Revenue Integrity etc.) to ensure that the organization’s complex health plan contracts meet the constantly changing reality of EH’s operations and resolves any corresponding issues.
•May become responsible for the supervision of staff
•Performs other duties as assigned.
License, Certification, Education or Experience:
REQUIRED for the position:
•5 years of experience with health insurance payment methodologies and managed care concepts
•Experience with provider/hospital operations and/or health insurance
•Experience with patient financial accounting and data analysis
•Strategic thinking, planning and project management
•Experience with negotiating contractual language and payment rates
•Ability to problem solve effectively and creatively
•Ability to be proactive, self-directing and take initiative
•Facilitation, conflict resolution, problem-solving, persuasion and analytical skills
•Knowledgeable about managed care operational requirements, financial models, and system perspectives.
•Ability to work collaboratively with managed care, decision support and other financial analysts and guide necessary data analysis.
•Ability to review and address legal contract language.
•Ability to manage multiple projects concurrently with multi-disciplinary teams.
DESIRED for the position:
•3 years of formal project management or leadership experience
•Experience with Decision Support systems