Bon Secours Mercy Health Director, Payer Contracting in Cincinnati, Ohio
Thank you for considering a career at Bon Secours Mercy Health!
DIRECTOR, PAYER CONTRACTING | Cincinnati, OH
This position is responsible for developing, managing, and leading the day-to-day activities associated with managed care contracting for both fee for service and risk agreements within a specified market. The work of the incumbent will be focused on developing and implementing new insurance and risk-based contracts and on evaluating, monitoring and maintaining existing insurance and risk-based contracts. The contracts will primarily include facilities, ancillaries, physicians, PHO’s and clinically integrated networks for a specific state where Bon Secours Mercy Health operates.
Leads assigned negotiations of fee for service, and value based (including risk, pay for performance) contracts for all Bon Secours Mercy Health in a specific state for Bon Secours Mercy Health. This scope of contract management will range in revenues between $50m and $4b in commercial revenues.
Develops innovative, mutually beneficial economic and clinical alignment agreements that leverage BSMH’s clinically integrated networks and collaborates with physician and operational leadership of Pop Health.
Employing a strong financial background and critical thinking skills, analyzes and facilitates the financial analyses and contract language negotiation for hospitals and physicians necessary to support the accuracy and profitability of fee for service and value based managed care contracting initiatives.
Plays a key role in Payor relationships to set the stage for future initiatives and to support existing agreements, both fee for service and value based.
Coordinate initiatives and with cross functional teams including individual markets and their leadership teams, Marketing & Communications, Finance, Revenue Cycle & Pop Health. Works closely with these groups to develop strategic plans for payors and markets including narrow network alternatives to grow attributed lives.
Work within the markets as necessary on the standardization of processes, reporting and approaches to payor contracting, payor relationships, network participation and other strategic projects from time to time.
Participates in short and long-term projects, as needed.
Maintains knowledge and understanding of the current trends and developments in healthcare reimbursement and development of specific payor strategies, including investigation of new business opportunities, regulations, standards and directives regarding governmental/third party agencies (Medicare & Medicaid) and/or third-party payors.
Adheres to the standards and policies of the Corporate Responsibility Program, including the duty to comply with applicable laws and regulations, and reporting to designated Manager (or employer hotline) any suspected unethical, fraudulent, or unlawful acts or practices.
Participates in and encourages associates to participate in activities that benefit the community.
Performs other duties and responsibilities as may be assigned from time to time.
Bachelors Degree in Business Administration or Healthcare Administration or closely related field (with an adequate understanding of healthcare finance)
5 years of Managed Care contract operations, analytics, hospital contracting or payor contracting experience.
Excellent interpersonal skills to interact with all levels of staff, outside vendors, consultants, and physicians.
Strong analytical, verbal and presentation skills; experience in financial modeling and reimbursement technologies; proficient in spreadsheet and database programs as well as legal and contractual compliance issues.
Ability to establish relationships with internal customers and managed care entities.
A broad knowledge of the healthcare industry, insurance, managed care and integrated delivery systems as well as employer benefit plans.
A background in healthcare finance, payor reimbursement methodologies and decision support leadership are preferred.
Must have the ability to timely and accurately mine data from various internal and external sources and organize information in a meaningful way for presentation and analysis.
Must possess critical thinking skills, an ability to work cooperatively with others and have a positive, willing attitude.
Geographic mobility as necessary.
- Graduate Degree in Healthcare Administration, Accounting or Finance
Bon Secours Mercy Health is an equal opportunity employer.
We’ll also reward your hard work with:
Comprehensive, affordable medical, dental and vision plans
Prescription drug coverage
Flexible spending accounts
Life insurance w/AD&D
An employer-matched 403(b) for those who qualify
Paid time off
And much more
S cheduled Weekly Hours:
Days (United States of America)
SS Revenue Management - Managed Care
All applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, sexual orientation, gender identity, age, genetic information, or protected veteran status, and will not be discriminated against on the basis of disability. If you’d like to view a copy of the affirmative action plan or policy statement for Mercy Health – Youngstown, Ohio or Bon Secours – Franklin, Virginia; Petersburg, Virginia; and Emporia, Virginia , which are Affirmative Action and Equal Opportunity Employers, please email email@example.com. If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact The Talent Acquisition Team at firstname.lastname@example.org .