Director Payer Relations and Contracting

The Director Payer Relations and Contracting will lead staff and processes for payer (commercial and government) relationships and contracting, including partnering with the Vice President to negotiate contracts and manage the payer portfolio, oversee and perform contract analytics, maintain currency on payer/provider benchmarking and best practices and payment policies/programs, and reviews and routes for approval Single Case Agreements.

• N/A

• Bachelor's Degree: Related Field or
• Bachelor's Degree: Economics or
• Bachelor's Degree: Finance or
• Experience In Lieu of Education

• Related field - 10 years

Specialized Skill & Knowledge

• Requires strong interpersonal and negotiation skills for 3rd party payer negotiating and relationships.
• Strong analytical, problem-solving and leadership skills.
• Demonstrated ability to develop and manage team members effectively as well as other areas within Carle that are impacted by payer contracts.
• Demonstrated ability to work independently and as part of a collaborative team.

• Partners with Vice President to negotiate contracts and manage payer portfolio including commercial contracts, Medicare Advantage agreements, Medicaid managed care, employer direct contracts.
• Contract analytics - model reimbursement impacts, fee schedules, escalators, utilization assumptions.
• Develop, maintain, and administer specific written procedures to identify expiring contracts that need to be renegotiated.
• Develop, maintain, and administer specific written strategy for contract negotiation procedures.
• Understands Carle billing and pricing policies and can communicate those policies to payers and understands how Carle policies align or are in conflict with payer policies.
• Responsible for day-to-day contract administration, amendments, and renewals.
• Responsible for communicating throughout Carle any changes and updates on payer contracts and for ensuring that impacted administrative and clinical departments have had input on new contracts and changes to existing contracts.
• Provides primary support for payer relationships.
• Develops and cultivates relationships with staff from Patient Financial Services, Revenue Cycle Systems, and Patient Access to facilitate communications regarding payer opportunities and issues.
• Manages payer/provider industry benchmarking and best practices and stays current on commercial and governmental payer policies and programs.
• Reviews and approves (or routes for approval) Single Case Agreements in accordance with established contract standards.

The compensation range for this position is $56.86per hour - $97.8per hour. This represents a good faith minimum and maximum range for the role at the time of posting by Carle Health. The actual compensation offered a candidate will be dependent on a variety of factors including, but not limited to, the candidate’s experience, qualifications, location, training, licenses, shifts worked and compensation model. Carle Health offers a comprehensive benefits package for team members and providers. To learn more visit careers.carlehealth.org/benefits.