Director of Payor Contracting
Overlake Medical Centers has a opening for our Director of Payor Contracting. This person will be responsible for payor contract relationship, negotiation and interdepartmental support for all payor and reimbursement contracts. Coordinates all efforts, both internally and externally, related to all reimbursement related components. Strong understanding of value based payer contracting a must. Coordinates among a number of departments within Overlake to achieve the areas objectives.
- Plan and integrate functions and services to support Overlake’s goals and priorities.
- Build effective working relationships throughout the organization with managers, staff, physicians, customers and suppliers.
- Provide leadership for effective service:
- Communicate Overlake Hospital vision and priorities and facilitate development of team and individual goals in alignment with organization goals.
- Establish performance expectations and provide coaching to achieve positive results. Recognize effective performance, and address performance needing improvement in an honest and timely manner.
- Empower staff to make decisions by providing information and tools.
- Serve as an effective role model of Overlake’s Shared Valuess and encourage staff to develop and demonstrate those values.
- Continually assess and improve care and services provided to meet or exceed the needs and expectations of customers. Foster continuous quality improvement by leading teams in use of quality management tools and processes.
- Manage organizational resources with fiscal responsibility and promote effective allocation and utilization.
- Establish strong insurer contacts and coordinate meetings with insurers to negotiate managed care contracts. Coordinate contracting requirements with Patient Financial Services, Patient Access, Revenue Integrity, Utilization Management and other departments that will be significantly impacted by contract changes.
- Disseminate contract and state and federal program information to Patient Financial Services, Patient Access, Revenue Integrity, Utilization Management, Financial Planning and other affected departments when contracts are updated.
- Coordinate with insurers, Patient Financial Services, Patient Access, Revenue Integrity, and Utilization Management to correct systemic billing and authorization issues impacting cash flow and contract terms.
- Complete ongoing formal reporting of plans, strategies and status of payor contract negotiations to the Chief Financial Officer. Draft written strategies and analyses for options and alternative managed care and risk contracting for the Chief Financial Officer and Executive Leadership Team.
- Develop and maintain required policies, procedures, analyses and routine reports for gross and net hospital revenue for managed care contracts, and managed care analysis.
- Develop standard and ad-hoc Alliance reporting and analyses to support insurance contract negotiations and contract management in alignment with Patient Financial Services.
- Under the Chief Financial Officer, maintain the Hospital’s contract management system.
- Manage and direct underpayment review and collection process to recover payments from insurers that do not meet expected contract reimbursement.
- Manages the contract negotiation process for Eastside Health Network. Establishes processes for claims tracking and reporting and recovery of settlements due.
- Administrative staff lead for the Eastside Health Network Contracting Committee. Works on a routine basis with the Executive Director and Physician Chair to share applicable information to the EHN contracting committee.
- Coordinates new payer contracts, programs, and/or payment methodologies and leads implementations, as needed.
- Manage annual revenue budget analysis and share assumptions and results with the Chief Financial Officer
- Manage annual charge description master (Charge Master) price changes and model the estimated impact on net revenue for each fiscal year.
- Develop standard and ad-hoc financial reporting and analyses to support Eastside Health Network risk and/or incentive insurance contracts.
- Leadership Incentive Plan
- Free public transportation pass (ORCA orcacard.com)
- Competitive compensation package
- Generous PTO
- Medical, dental, vision
- 2 part retirement plan including matching
- Long term disability
- Flex spending
- Extended illness banked hours
- Free parking
- Employee Assistance program
- Professional development
Just a few of our employee perks
- Cell phone plan discounts
- Discounted Mariners and Sounders tickets
- Computer discounts
- Discounted lift tickets
- Discounted movie tickets
- Discounted gym memberships
- Free Seattle Art Museum passes
- And much more
- Bachelors degree required.
- HFMA membership desired.
- Minimum of five years in financial management, of which three must be in in payor contracting and reimbursement, either on the payor side or within a medium or large hospital or healthcare system.
- Strong experience in computerized hospital financial decision support and service line analysis. Direct payor negotiating experience required. Avega (Harris) or similar experience preferred. Required - highly proficient in Microsoft Excel, Word and Access including import/export functions. Required – strong written and verbal communication skills.
Overlake is committed to providing ready access to a highly trained and compassionate medical team, who are consistent and comprehensive in coordination of care for all patients. Our group practice champions superior quality-of-care, superior outcomes, a superior patient experience, and work-life balance. We believe exceptional patient care comes naturally when our employees feel respected, valued and cared for too. These high standards and high expectations will give us the ability to recruit and retain the best healthcare teams in the region.
Overlake Medical Center is an Equal Opportunity Employer