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 departments.
- Leads disparate groups in problem solving exercises resulting in favorable outcomes.
- Unit, Staff, and Personal Development
- Contributes to building, leading, and developing a team of payer contracting professionals providing training and resources.
- Fosters team's growth.
Takes advantage of leadership training, self-development and learning opportunities.
Qualifications
- Bachelor's Degree in a relevant subject area such as Accounting, Finance, Business or Health Care Administration - required
- Master's Degree in a relevant subject area such as Business or Health Care Administration - preferred
- 7-9 years experience in the management and negotiation of health care payer contracts or network management experience in an insurance or health care setting. - required
- Experience working in a health care system and/or large, academic, or complex health care setting that included payer contracting - preferred
- Experience working in a hospital as well as physician group setting - preferred
- Demonstrated success in negotiating complex payer contracts in a competitive market including both new and renewals.
- Demonstrated success in managing large volumes of high dollar contracts including renewal provisions, day to day compliance and operations, and payer relationships.
- Knowledge of current federal and NYS regulations regarding managed care contracting, as well as the provision and reimbursement of medical services including, but not limited, to Medicare and Medicaid.
- Knowledge of risk-based and other value-based reimbursement models.
- Demonstrated knowledge of the current health care insurance landscape both nationally and locally.
- Demonstrated strategic and System thinker coupled with organizational and critical thinking skills.
- Demonstrated analytic capabilities with the ability to prepare effective reports, interpret and/or present information and data using Microsoft/excel and other tools.
- Exemplary interpersonal, verbal, and written communication skills to include the ability to negotiate, resolve conflicts, and build teams.
- Ability to operate independently in high pressure situations and manage effectively in a quick paced, highly matrixed environment; knows how to collaborate effectively and when to seek guidance from SMEs.
- Proven leadership capabilities showing a history of building positive relationships across disparate teams or organizations, influencing decisions positively, showing sound judgment, high energy, prospectivity, flexibility and focus.
Equivalent combination of relevant education and experience may be substituted as appropriate.
Thank you for your interest in Albany Med Health System!
Albany Med Health System is an equal opportunity employer.
This role may require access to information considered sensitive to Albany Med Health System, its patients, affiliates, and partners, including but not limited to HIPAA Protected Health Information and other information regulated by Federal and New York State statutes. Workforce members are expected to ensure that:
Access to information is based on a “need to know” and is the minimum necessary to properly perform assigned duties. Use or disclosure shall not exceed the minimum amount of information needed to accomplish an intended purpose. Reasonable efforts, consistent with Albany Med Health System policies and standards, shall be made to ensure that information is adequately protected from unauthorized access and modification.
