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Coeur d'Alene

    Director, Payor Strategy and Contracts - Coeur D'Alene, United States - Idaho State Job Bank

    Idaho State Job Bank
    Idaho State Job Bank Coeur D'Alene, United States

    6 days ago

    Idaho State Job Bank background
    Description
    Director, Payor Strategy and Contracts at Kootenai Health in Coeur d'Alene, Idaho, United States Job Description Director Payor Strategy and

    Contracts Job Code: 28383 Position Summary Responsible for payer strategy development, contract negotiations, payer collaboration and relations, pay for performance, financial analysis, payer performance monitoring, contract operationalization, and payer issue resolution.

    Responsibilities
    • Develops and executes commercial payer strategies in conjunction with CFO
    • Negotiates commercial payer contracts utilizing consistent language and reimbursement methodologies to ensure that contracts are aligned with KH strategies
    • Establishes and maintains active, positive relationships with Executive Leadership, Revenue Cycle leadership and Legal to ensure communication regarding service level performance and issue resolution
    • Operationalizes and implements contracts and contract updates within KH and Revenue Cycle, including monitoring programs and denial management programs
    • Communicates and implements payer policy changes KH and Revenue Cycle.
    Monitors compliance with payer requirements and provides additional training when needed
    • Monitors payer financial and operational performance and proactively implements payer corrective actions and improvement activities when required
    • Establishes and maintains active, positive relationships with payer senior leadership with contracted payers.
    Identifies opportunities for payer collaboration and implements collaborative programs
    • Serves as liaison between KH and payers within region
    • Provides regular payer reporting package, including payer report cards, to Executive Leadership
    • Develops and maintain profiles of key payers, buyers and brokers to assist in developing strategies, decision making and proactively identifying payer and health insurance trends
    • Develops, implements and monitors payer pay for performance initiatives.
    Works with clinical leadership at KH to ensure maximum realization of revenue
    • Manages and mentors payer contracting staff.
    Prepares budgets and manages use of resources within budget targets
    • Maintains a working knowledge of applicable Federal, State and local laws/regulations; the KH Integrity and Compliance Program and Code of Conduct; as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior
    • Performs other related duties as assigned
    • Familiar with standard concepts, practices, and procedures within the field
    • Relies on experience and judgment to plan and accomplish goals
    • Regular and predictable attendance is an essential job function
    • Competent to meet age specific needs of the unit assigned Requirements and Minimum Qualifications
    • Bachelors' degree in Finance/Accounting, business or healthcare related field required; Master's degree preferred 7 years' relevant experience at an insurance company or healthcare environment required
    • Experience in payer contract negotiation
    • Excellent analytical skills and ability to manipulate large data sets from multiple systems
    • Familiarity with current common coding practices including CPT4, ICD9CM, and DRGs as well as current Medicare reimbursement methodologies and quality initiatives
    • Knowledge of pricing, healthcare finance, managed care, provider incentives, and risk contracting required
    • Knowledge of quality and outcome measures aligned with health plan scoring and ratings, including STAR ratings
    • Understanding of healthcare expense risk for populations, its components (unit price and frequency), and drivers Working Conditions
    • Must be able to maintain a sitting position
    • Typical equipment used in an office job
    • Repetitive movements Kootenai Health complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, veteran status, or sex.
    Kootenai Health does not exclude people or treat them differently because of race, color, national origin, age, disability, veteran status, or sex. To view full details and how to apply, please login or create a Job Seeker account
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