- Lead a team responsible for driving payor contracting and pricing negotiations across all lines of business to maximize growth and performance.
- Develop and maintain relationships with third party payors, including commercial insurers, self-funded employers, government agencies, workers comp, and others.
- Manage staff to include selection, work allocation, training, coaching, mentoring, problem resolution, performance evaluation, feedback, and disciplinary action as needed.
- Work closely with legal, billing, and compliance on active negotiations, and, when necessary, to productively resolve payment and/or billing disputes.
- Stay abreast of industry changes to rules and regulations governing the payment for services provided to federally-funded patients.
- Assist with contracting for employer services as a growing business segment for Value-Based Care
- Collaborate with Finance to create BI tools, complete payor analyses, and provide active updates to assist with the budgeting process.
- Partner with Operations to drive profitable access and pull-through efforts.
- Partner with leadership to ensure that contracting efforts align with company and divisional goals
- Education:
- Bachelors degree required; Masters or professional degree in Business or Health Administration preferred
- Work Experience:
- Minimum 7 years experience in managed care contract negotiations from a payor or provider lens
- Experience negotiating managed care contracts with spend or revenue in the tens of millions of dollars (US $) is strongly preferred
- Experience with Ancillary (PT / OT) contracting is strongly preferred
- Work Comp contracting experience preferred
- Both payor (national or regional) and provider managed care contracting and/or pricing experience is a plus
- Experience with Independent Physician / Provider Associations (IPAs), Clinically Integrated Networks (CINs), etc. is a plus
- Minimum 5 years management level experience
- Certification/Licensure:
- None required
- Knowledge and Technical Skills:
- Strong Fee-For-Service managed care contracting or pricing proficiency; owning negotiations or cross-functional payor-based projects end-to-end, driving to completion on a deadline
- Sound experience with managing and driving multiple in-flight negotiations or payor-based projects at different stages
- Strong understanding of government reimbursement
- Proficient working knowledge of different provider reimbursement methodologies required (fee schedules, per diems, per visit rates, etc.)
- Proficient in Microsoft 365, including Excel, MS Word, PowerPoint and Outlook
- Proven ability to clearly organize and effectively convey information
- Demonstrated ability to work effectively with both internal and external customers
- Ability to read, write and speak English proficiently
- Ability to fulfill office activities including but not limited to remain stationary for extended periods of time (i.e., while working at a desk), stoop/kneel/crouch, travel around the office, communicate with others (verbal and written), and use fine motor skills including fine hand manipulation and keyboarding.
- Ability to see at close range, distance vision, peripheral vision, depth perception, and the ability to adjust focus
- Occasionally lift and/or move up to 20-25 pounds
- Consistent with a standard office environment, noise level is low with little to no extraordinary environmental factors.
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Director, Payor Relations - Oak Brook, United States - Athletico Physical Therapy
Description
Position Overview:
Greater Purpose and Core Values:
Athleticos Greater Purpose is to empower people, inspire hope and transform lives. We accomplish this by providing exceptional, progressive, and cost-effective fitness, performance and rehabilitative services through personalized care that emphasizes education and prevention of future injury. This is accomplished through building on our Core Values of one team, understanding our business, recognition, people-focused, accountability, continuous innovation and trust and integrity, which are the foundation for our unique culture.
Position Summary:
The Director, Payor Relations serves as an experienced managed care leader to the organization leading, and managing a core Payor Relations contracting team. The Director, Payor Relations has responsibility for all payor contracts to ensure optimum reimbursement, value and performance, leveraging strong relationships with payors across all lines of business (e.g., Group health, Work Comp, Medicaid, Medicare Advantage and more). This role owns pricing analysis, monitoring performance of executed agreements, and end-to-end contract negotiations. This position also serves as a liaison between Athletico and payors of all types across all lines of business nationally, regionally, and locally.
Essential Duties and Responsibilities:
Qualifications
Language Skills
Physical Demands:
Work Environment:
Athletico provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.
