Responsible for technical and professional payer contracting, credentialing, and pricing for the entire Health System. Provide guidance and support to Senior Leadership in aspects of payer contracting/negotiations, pricing, and delegated credentialing for the Health System. Responsible for pivoting and adapting NCHS to an everchanging payer landscape and reimbursement structure. Be a role model and leader to subordinates and develop a strong educated and impactful team bench.
Job Specific Duties
Responsible for detailed understanding of health care industry, market dynamics, trends, competitors, regulations, and payer environment.
Collaborates with the management team and all departmental levels on both the hospital and physician sides. Ensure operational issues are addressed and remedied through negotiation, project planning, or contract modification.
Creates and maintains professional relationships with payers and potential affiliates.
Creates, analyzes, and interprets financial reports to support payer negotiations, trends, and audit.
Implements and communicates contracting strategies in collaboration with Senior Leader.
Manages all out of network contracting for both hospital and employed physicians.
Responsible for the management and development of subordinates.
Knowledge and willingness to support new value based transformational contracting strategy at the right time in the right setting.
Provides direction, feedback, and recommendations on trended payer performance; serves as the SME for all payer related contractual arrangements/issues- current and historical.
Responsible for overseeing the management of all in network and out of network contracting and negotiations for the hospital and employed physician group.
Responsible for making high impact decisions steeped in judgment.
Develop and lead Joint Operating Committee meeting with payers and respective NCHS departments.
Complies with legal and regulatory compliance requirements.
Leads and oversees Corporate Pricing function.
Leads and oversees Corporate Credentialing function.
Minimum Job Requirements
Bachelor's Degree Business Administration or Health Management
4-7 years Management experience in the healthcare finance/payer/managed care contracting field
7-10 years Hospital and/or payer negotiations and analysis experience
Knowledge, Skills, and Abilities
MBA or MHA preferred.
Work well under immense pressure with an ability to focus on multiple priorities while maintaining focus, attention to detail, and connecting all the dots.
Demonstrated leadership progression.
Knowledge of fee for volume and fee for value reimbursement methods.
Strong contract review and interpretation skills.
Familiarity working with Lawyers and interpreting statutes and regulations.
Business acumen and strong financial skills.
Excellent written, oral, and communications skills.
Success in persuasion, influence, and negotiation skills.
Management expertise, strong knowledge of data analysis, and statistics.
Able to handle day to day administrative routine, as well as, constantly changing, competing projects, urgent situations, sometimes simultaneously.
Able to relate cooperatively and constructively with payers and co-workers.
Effective communicator with a strong, transparent, and clear style; ability to deliver tough messages with tact.
Effectively monitor and develop the abilities of subordinates.
Able to maintain confidentiality of sensitive information.
Knowledge of payer and hospital credentialing function.
Ability to interpret, adapt, and react calmly under stressful conditions.
Ability to analyze and interpret complex models and apply to business ask; strong spreadsheet skills.
Ability to use logical & scientific thinking to interpret technical data and solve a broad range of problems.
Able to relate cooperatively and constructively with medical staff, executives, staff, elected officials, and managed care companies.
Nicklaus Children’s Health System, is the region’s only healthcare system exclusively for children. In addition to Nicklaus Children’s Hospital and a growing number of outpatient centers located throughout the tri-county area, the health system includes Nicklaus Children’s Hospital Foundation, the organization’s fundraising arm; Nicklaus Children's Pediatric Specialists, a nonprofit physician practice subsidiary; a management services organization, and an ambulatory surgery center. Our vision is to be where the children are. Ultimately, this means being there through all stages of health and life, both physically and emotionally. To be a trusted partner to children and their families, not only in times of illness, but throughout their life journey. Our mission is to inspire hope and promote lifelong health by providing the best care to every child.