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Director, Alternative Payments Contract Management

Requisition R098402 Market Remote Department SS Revenue Management - Revenue Management Shift Days Schedule Full-time

Thank you for considering a career at Bon Secours Mercy Health!

DIRECTOR, ALTERNATIVE PAYMENTS CONTRACT MANAGEMENT | Work From Home/Remote

The position of Director, Alternative Payments Contract Management will support the development and execution of BSMH alternative payments contracting strategy. The candidate will establish working relationships with managed care payers for assigned programs and efficiently balance demands of multiple accounts to ensuring timeliness, contract compliance and performance results. He or she will facilitate strategic growth discussions with payer and internal stakeholders to identify new payer partnerships, program opportunities and progression along the risk continuum. He or she will be the subject matter expert for program requirements, educating key stakeholders, providing guidance and recommendations during contract negotiations, identifying program issues / opportunities and evaluating program results.The director will be assigned a specific book of business to lead in all aspects.

Essential Functions

  • Advise Senior Leaders on emerging trends and methodologies for managed care alternative payment models, CMS models of payment and Medicaid programs

  • Collaborates with analytical resources to quantify the impact of alternative proposals for new and renewing programs and program audits. Facilitating the reconsideration process as applicable.

  • Collaborates with leadership teams in the planning, assessment, design and implementation phases for alternative payment model programs.

  • Deliver education and training to key stakeholders on assigned programs focusing on program requirements and contractual terms.

  • Develops, assesses, and makes recommendations on program participation, improvements and renewals.

  • Facilitate oversight meetings with payers to monitor and discuss contract performance

  • Consult with key stakeholders to ensure program aligns with operational and clinical capabilities. Providing guidance on contract and program interpretations and requirements.

  • Manage ongoing relationship and performance of alternative payment contracts, including identifying opportunities for performance improvement, review of reporting, validation of adherence to contractual terms, and facilitate resolution of issues.

  • Negotiate alternative payment model program terms and contract language for acute, ambulatory and Clinical Integrated Network in conjunction with Finance, Population Health and Managed Care.

  • Ensure all contract terms are in alignment with BSMH contracting priorities and objectives.

  • Support the development of managed care and governmental payer strategies and initiatives to adapt to ongoing healthcare payment reforms and evolving payment methodologies, including ACOs and value-based care initiatives

  • Supports governance and management meetings to include facilitation, planning and coordinating and follow-up

REQUIRED:

- Bachelors Degree in Business, Healthcare Management, Accounting, Finance or Related Field.

- Minimum of five years’ healthcare management experience involving complex delivery systems and organizations

- Effective negotiation and communication skills, plus the ability to utilize and interpret financial models and internal analyses.

- Knowledge of Managed Care, Finance, alternative payment methodologies, claim billing (CPT, HCPCS, ICD-10, DRG, etc.

- Self-starter, and proven ability to work well in a matrixed environment.

- Demonstrated project management skills with a successful track record.

- Proficiency with MS Office applications and web-based technologies.

- Excellent interpersonal communication with the ability to influence at all levels of the organization.

- Demonstrated ability to handle highly sensitive and confidential information in compliance with Health Insurance Portability and Accountability Act (HIPAA), and company confidentiality policies and procedures.

PREFERRED:

- Graduate Degree in Business, Healthcare Management, Accounting, Finance or Related Field.

- Experience evaluating, developing and/or negotiating value-based contracts

- Strong relationship building and influencing skills.

- Willingness to travel approximately 25% for face to face meetings.

- Excellent time management and prioritization skills.

- Highly collaborative team approach to work.

- Strong problem-solving skills, including the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action

Bon Secours Mercy Healthis 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
  • Educational Assistance
  • And much more

Scheduled Weekly Hours:

40

Work Shift:

Days

Department:

SS Revenue Management - Revenue Management

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 recruitment@mercy.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 recruitment@mercy.com.

Apply Now
Luis F., RN

I wanted to get into a career where I’m happy to go to work.

Luis F. Registered Nurse
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