Manager of Payor and Market Strategy

Position Title

Manager of Payor and Market Strategy

Days - Full Time

Southlake Campus

The Manager of Payor and Market Strategy, under the supervision of the Director of Managed Care, is responsible for the negotiation or renegotiation contracts with managed care companies and health plans which accounts for 70% of the health system revenues. This position enhances our managed care program by analyzing contract opportunities to increase or maintain market share and develop strategies for different product and relationships.

The negotiation role includes developing, evaluating and responding to rate structures and rate levels for all services and locations across UKHS including but not limited to, hospital inpatient and outpatient services, ambulatory surgery center, physicians, transplant services, behavioral health, home infusion, and other professional services. This position will have responsibility regarding managed care contracting, internal and external payer related relations, and contracting support.

Responsibilities and Essential Job Functions

• Must be able to perform the professional, clinical and or technical competencies of the assigned unit or department. Negotiation
• Assist in the development of the negotiations and renegotiations strategy of the managed care contracts to achieve the overall goals of the health system.
• Report market opportunities and monitor significant changes to protect and enhance market share for the health system.
• Educate and assist in the development of varying contract structures for reimbursement including full range of hospital, physician, ASC, bundled, value based, capitative or others to other key internal departments.
• Analyze contract requirements, special provisions, terms and conditions to ensure compliance with appropriate laws, regulations and UKHS policies and procedures. Seek director and legal input when necessary.
• Analyze rates of proposals and counter proposals using various contract modeling tools including but not limited to EPIC contract modeling, Excel, and Access.
• Meet with health plans and payers including development of key agenda items and preparation for negotiations, as well as joint operating committee meetings.
• Ensure contract language terms meet the needs of the health system financially and operationally, work collaboratively with the director and legal counsel to ensure regulation terms are compliant.
• Monitor contract performance and other provisions to ensure compliance, identify potential problem areas and help internal staff resolve disputes.
• Coordinate with the contracting team on behalf of all the entities.
• Ongoing analysis of existing contracts for compliance and performance
• Analyze historical utilization and trends in revenues, by reviewing financial data reports to identify issues with operations of contracts.
• Update directors of contracting on unexpected changes in the planned performance of contracts.
• Engages payers to ensure that UKHS is not excluded or disadvantaged as payers adapt or change their plans and implement policies and/or procedures.
• Develop standard reports and maintain skills for ad hoc reports
• Assist with reporting needs for budget purposes, revenue projections and long-range planning.
• Serve as liaison with Revenue Cycle and other operational departments
• Address operational issues with payers by proactively identifying issues, and soliciting information and feedback from Revenue Cycle regarding implementation and performance of contracts
• Provide ongoing assistance in processes, communication and interpretation of the language and intent of the contracts.
• Stay abreast of the changes in the insurance and payer market. Be knowledgeable and available as a resource for staff for issues…