Director, System Payer Contracting; On-site

Position: Director, System Payer Contracting (On-site)
Department/Unit:

Integrated Delivery Systems

Work Shift:

Day (United States of America)
Salary Range:$ - $This position is required to be in person and in office. The candidate will be required to attend and host in person meetings. The Director is responsible for overseeing as well as implementing, developing, maintaining, and benchmarking contractual relationships with payers/health plans in the AMHS market. Leading and mentoring, negotiating, continuous monitoring of contract performance, and engaging with internal and external stakeholders to optimize contracts or mediate issues requires the Director to possess exceptional leadership, organizational, analytic, and communication capabilities.

The Director ensures the team is leveraging multiple sources of data across the AMHS to facilitate best outcomes. To facilitate this, the Director is the primary liaison with AMHS analytics leadership. The Director oversees and leads the day to day operational, programmatic, financial, and employee related activities, as applicable, under the System Payer Contracting Unit. The Director prepares annual budget target recommendations in conjunction with AMHS Finance and other stakeholders.

The Director possesses deep 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 Director independently negotiates with established and new payers including leading economic assessments and overseeing contract implementation aligned with contract terms.

The Director is skilled at drafting, analyzing, and negotiating complex payer contracts. The Director develops contract proposals and leads in meetings, negotiations, presentations, and other contracting related functions. The Director mentors and coaches the team building on competencies enhancing professional development and retention. The 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 Director builds external relationships with payers' senior network management, leads meeting, oversees and/or prepares presentations, and is responsible for meeting budgetary and other established targets. Additionally, the Director continuously assesses payment and market opportunities in alignment with the AMHS Strategic Plan, including risk based/value-based initiatives. The Director concisely consolidates and presents such opportunities to key stakeholders and senior organizational leadership to influence and support AMHS's continued evolution of its payer contracting strategies.

The Director works together with the Vice President to continuously evolve AMHS's payer strategies.

This position is required to be in person and in office. The candidate will be required to attend and host in person meetings.  

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 and Oversight 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…