Director of Contracts and Payer Relations

US-AZ-Phoenix
Job ID
2017-2189
# of Openings
1
Category
Contracts/Credentialing
Program
Administrative
Weekly Hours
40

Overview

Terros Health, Inc. is a four decade old, fully integrated community healthcare provider: With over 30 clinics throughout the Phoenix metro area, including Tucson, Flagstaff and Prescott Arizona. We have an exciting and immediate need for an experienced Director of Payer Relations. As one of the state’s leading, healthcare providers: Terros Health offers great work-life-balance, and continued career progression. Each new hire is eligible to participate in our best-in-class employee benefit plan the 1st of the month following their date of hire.

Benefits include:

  • Medical insurance: PPO Health Reimbursement, HDHP Health Savings Account, and a traditional PPO
  • Vision insurance
  • Dental and Orthodontics insurance
  • Flexible Spending Accounts
  • Accidental Death & Dismemberment insurance
  • Disability insurance
  • Paid Life insurance
  • 401K with company matching (No company matching for the first 6 months of employment)
  • Employee Assistance Program
  • Financial Consultation and Referrals
  • Family & Caregiving Resources and Referrals
  • Legal Consultations
  • Paid Holidays
  • Generous paid time off/Vacation time
  • Paid sick time
  • Tuition discounts through our strategic partnership
  • Employee discounts at LA Fitness athletic clubs
  • Employee discounts on car rental through Enterprise Rental Car

If you've been in search of a growing organization with a forward thinking, and caring culture: Terros Health may be the company you’ve been looking for.

Responsibilities

The Director of Payer Relations is responsible for the strategic planning and management of Terros Health contract negotiations, network participation, and relationship management in accordance with the organization’s strategic business plan. They will monitor performance and viability of payer agreements, review and analyze provider reimbursement, and participate in the negotiation and re-negotiation of payer agreements. Provides leadership to key revenue cycle activities, including contracting, licensing, credentialing and adherence to regulatory requirements.  

 

Areas of responsibilities

  • Develops payer contracting strategy and facilitates the negotiation of contract terms and rates with health plans and payers.
  • Support Terros Health in greater implementation of Value-Based Contracting Models, Capitation, Incentive Plans and other Alternative Payment Models.
  • Anticipate the impact of contract changes and communicate across Terros Health.
  • Responsible as primary lead for organization in communications to payers for contract negotiations, policy clarifications, issue resolution, updates, etc.
  • Collaborate with finance to analyze payment trends and utilize findings in negotiations.
  • Develop strong relationships with vendors, payers, regulators and health plans to ensure streamlined problem resolution and maximized opportunities.
  • Uses knowledge of industry, billing, and coding to maximize revenue collection through efficient licensing, credentialing, and setup of facilities and providers.
  • Leads and supervises credentialing staff ensuring the continual optimization of the credentialing and privileging process
  • Lead contracts, health and safety and credentialing staff, ensuring the highest level of customer service to both internal and external customers.
  • Streamline contracting process to ensure accuracy of contract language and the ability to execute required deliverables and regulatory requirements  
  • Serve as subject matter expert on regulatory requirements ie. licensing, AHCCCS, and CMS
  • Track and monitor industry news, changes and trends related to payment reform, regulations and opportunities.

Qualifications

 Bachelor's degree preferred

  • 5 years of experience with a variety of health insurance payment methodologies and managed care concepts.
  • Strong working knowledge of claims, coding, credentialing, and licensing.
  • Excellent data analysis skills
  • Strategic thinking, planning and project management.
  • Experience with negotiating contractual language and payment rates.
  • Ability to problem solve effectively and creatively
  • Ability to be proactive, self-directing and take initiative
  • Facilitation, conflict resolution, problem-solving, persuasion and analytical skills
  • Experienced leader/manager with exceptional people skillsBig picture thinker with ability to prioritize and reimagine
  • Ability to review and address legal contract language.
  • Ability to manage multiple projects concurrently with multi-disciplinary teams
  • Experience in the managed care space highly preferred 

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