Director Payer Relations and Contracting

Overview

Responsibilities

• Partners with Vice President to negotiate contracts and manage payer portfolio including commercial contracts, Medicare Advantage agreements, Medicaid managed care, employer direct contracts. 
• Contract analytics - model reimbursement impacts, fee schedules, escalators, utilization assumptions.
• Develop, maintain, and administer specific written procedures to identify expiring contracts that need to be renegotiated.
• Develop, maintain, and administer specific written strategy for contract negotiation procedures.
• Understands Carle billing and pricing policies and can communicate those policies to payers and understands how Carle policies align or are in conflict with payer policies.
• Responsible for day-to-day contract administration, amendments, and renewals.
• Responsible for communicating throughout Carle any changes and updates on payer contracts and for ensuring that impacted administrative and clinical departments have had input on new contracts and changes to existing contracts.
• Provides primary support for payer relationships.
• Develops and cultivates relationships with staff from Patient Financial Services, Revenue Cycle Systems, and Patient Access to facilitate communications regarding payer opportunities and issues.
• Manages payer/provider industry benchmarking and best practices and stays current on commercial and governmental payer policies and programs.
• Reviews and approves (or routes for approval) Single Case Agreements in accordance with established contract standards.

Qualifications

Certifications:

• N/A

Education:

• Bachelor's Degree: Related Field or 
• Bachelor's Degree: Economics or 
• Bachelor's Degree: Finance or 
• Experience In Lieu of Education 

Work Experience:

• Related field - 10 years 

Specialized Skill & Knowledge

• Requires strong interpersonal and negotiation skills for 3rd party payer negotiating and relationships.
• Strong analytical, problem-solving and leadership skills.
• Demonstrated ability to develop and manage team members effectively as well as other areas within Carle that are impacted by payer contracts.
• Demonstrated ability to work independently and as part of a collaborative team.

Carle Health Company Overview

Find it here.

Discover the job, the career, the purpose you were meant for. At Carle Health, we're committed to fostering a workplace where every team member feels valued, respected and empowered, where passion and purpose come together to positively impact the lives of our patients and our communities. Find it all at Carle Health.

Our nearly 17,000 team members and providers work together to support patient care across central and southeastern Illinois.  We’ve grown to include eight, award-winning hospitals and a multispecialty provider group with more than 1,500 doctors and advanced practice providers. We’re developing the next generation of providers and healthcare professionals through Carle Illinois College of Medicine, the world’s first engineering-based medical school, and Methodist College. Carle BroMenn Medical Center, Carle Foundation Hospital, Carle Health Methodist Hospital, Carle Health Proctor Hospital, Carle Health Pekin Hospital, and Carle Hoopeston Regional Health Center hold Magnet® designations, the nation’s highest honor for nursing care. We offer opportunities in several communities throughout central Illinois with potential for growth and life-long careers at Carle Health.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. | For more information: human.resources@carle.com.

Salary Range