Assistant Director, System Payer Contracting

Benefits

Additional Information

Department/Unit: Integrated Delivery Systems Work Shift: Day (United States of America) Salary Range: $116,823.00 - $186,917.00 The Assistant Director is responsible for implementing, developing, and maintaining contractual relationships with payers/health plans in the AMHS market. Negotiating, continuous monitoring of contract performance, and engaging with internal and external stakeholders to optimize contracts or mediate issues requires the Assistant Director to possess exceptional leadership, organizational, analytic, and communication capabilities. The Assistant Director leverages multiple sources of data across the AMHS to facilitate best outcomes. The Assistant Director leads the day to day operational, programmatic, financial, and employee related activities, as applicable, under the System Payer Contracting Unit. The Assistant Director possesses significant marketplace and payer contracting expertise to meet the high level, multifaceted competencies needed for the implementation and management of payer contracting strategies including building solid external payer relationships on behalf of all entities under the Albany Med Health System (AMHS). The Assistant Director independently negotiates with established and new payers including leading economic assessments and overseeing contract implementation aligned with contract terms. The Assistant Director is skilled at drafting, analyzing, and negotiating complex payer contracts. The Assistant Director develops contract proposals and leads in meetings, negotiations, presentations, and other contracting related functions. The Assistant Director must work within a highly matrixed environment cultivating strong internal working relationships often managing and influencing stakeholders across AMHS including but not limited to physician and hospital clinical leadership, legal, compliance, billing, finance, IT, case and utilization management, quality, credentialing, and other related departments. The Assistant Director builds external relationships with payers, organizes meeting, prepares presentations, and is responsible for meeting budgetary and other established targets. Additionally, the Assistant Director continuously assesses payment and market opportunities in alignment with the AMHS Strategic Plan, including risk based/value-based initiatives. The Assistant Director concisely presents such opportunities to key stakeholders and senior organizational leadership to influence and support AMHS's continued evolution of its payer contracting strategies. Essential Duties and Responsibilities Strategic and Operational Planning Contributes to System payer contracting strategic planning, budgets, and evaluation of payer partnerships. Forecasts and reports on market disruptions; stays on top of national and local payer trends. Planning and Program Development Identifies, facilitates, and builds systems and standardized processes to facilitate multi-stakeholder collaboration on payer contracts to achieve best negotiation outcomes. Develops timely, efficient payer issues escalation processes in support of revenue cycle and/or clinical operations that promotes payer accountability. Develops payer scorecard initiatives to measure payer compliance with contract terms and overall efficiency of payer operations; leads reviews with payers providing constructive feedback with aligned expectations. Develops and implements systematic payer contracting processes and procedures in order to ensure timely renewals, appropriate maintenance, and System-wide stakeholder education on contract terms and provisions. Forecasts and reports on national and local market trends including change management recommendations in the event of a pending market disruption; completes SWOT analyses. Creates annual goals and objectives for each contracted payer to ensure accountability and responsiveness Administrative and Cross-Functional Leadership Collaborates with various departments throughout AMHS to ensure payer contracting initiatives are integrated and aligned with broader organizational goals. Identifies and incorporates innovative payment models and initiatives aligned to enhance patient care and support operations. Ensures adherence to all federal, state, and local regulations for governing payer contracting, stays informed of the health care regulatory environment to mitigate risks. Engages staff and other stakeholders in continuous improvement of systems and processes; effectively manages resources, activities, and people. Influence and Relationship Management Exercises influence over payers to advance AMHS's interests, guiding negotiations and contracts towards favorable outcomes. Builds and manages relationships with existing and potential payer organizations ensuring effective communications and problem solving to maintain satisfactory payer partnerships. Promotes AMHS's value to payer constituency. Builds and manages relationships internal to AMHS across disparate depar