Senior Director, Payor Strategy and Contracting

Reporting directly to the Assistant Vice President, Payor Strategy and Contracting, the Senior Director of Payor Strategy and Contracting will be primarily responsible for assisting with the negotiation, implementation and oversight of payor contracts for HSS Florida. Using their experience and understanding of the Florida healthcare market, the Senior Director will work closely with internal stakeholders to establish, implement, promote and maintain partnerships with a variety of payor types that include both fee-for-service and value-based arrangements (i.e. pay-for-performance, bundles, etc.). They will work collaboratively with payor contacts and various internal HSS departments in New York and Florida to streamline contract operations, increase patient volume and practice revenue, manage quality performance metrics and troubleshoot issues. This includes using their understanding of the underlying contracts and leveraging payor relationships to ensure successful payor partnerships.

RESPONSIBILITIES:

• Collaborates with internal leadership to ascertain strategic payor contracting goals using insights from experience within the Florida Healthcare market.
• Is involved in contracting, implementing and maintaining operations for a variety of payor types including commercial plans, workers’ compensation payors, direct-to-employer partnerships and 3rd party network arrangements.
• Assists with the payor contract negotiation process, ensuring financial and strategic goals are met and translated into contractual language accordingly.
• Assists with analyzing payor contract proposals in conjunction with the analytics team to ensure contracts meet financial goals.
• Works collaboratively with the internal Payor Strategy and Legal teams to review and redline contracts as appropriate.
• Works collaboratively with HSS Florida practice, Ambassador Services, Marketing and Employer Strategy to successfully operationalize and promote new agreements
• Communicates with the revenue cycle and budget teams to ensure contracts are loaded appropriately into billing and decision support systems, and that financial projections are appropriately maintained.
• Leverages existing contacts and knowhow of the Florida healthcare market to establish and maintain successful payor partnerships.
• Serves as a primary point of contact with new and existing payor partners
• Escalates issues as necessary to payer contacts for resolution. In conjunction with Account Management, recommends escalation as appropriate to senior management.
• Assists in managing contract renegotiations, identifying patterned issues and opportunities to aid in the negotiation.
• Works with internal Payor Strategy and Quality teams to ensure that HSS Florida is tracking to performance targets and reporting deadlines as stipulated within agreements.
• Strategy implementation – works collaboratively with interdisciplinary subject matter experts, including Patient Accounts, Budget & Decision Support, Care Management, Revenue Cycle, Value Office, Strategic Partnerships and other areas as necessary
• Acts as an SME for relevant stakeholders on matters associated to the Florida payor and provider market
• Manages internal and external relationships to ensure Payor Strategy objectives are met and exceeded.
• Maintains up to date knowledge on the healthcare local and regional markets and reimbursement trends.
• Additional responsibilities as required to accomplish departmental goals.

EXPERIENCE, COMPETENCIES, AND PERSONAL CHARACTERISTICS:

• Experience (7-10 years) in payor or provider contracting, provider relations and/or network management.
• Experience dealing with a variety of payor types including commercial, workers comp and self-funded.
• Can communicate effectively with patient financial services professionals, providers and other key operational staff for both provider and payor organizations.
• Possesses key payor contacts and knowledge of payor contracting within the Florida Healthcare Market.
• Possesses strong leadership skills.
• Places high priority on overall team performance.
• Is detail oriented.
• Knowledge of the healthcare industry and payor reimbursement methodologies.
• Ability to work independently and collaboratively to solve complex problems.
• The ability to influence and motivate others, as well as work collaboratively within a multi-stakeholder environment is required.
• Excellent verbal and written communication skills.
• Excellent organizational and multi-tasking skills.
• Is professional when dealing with stakeholders. Uses good judgement and takes a thoughtful approach to resolving and communicating issues.

EDUCATION:

• Bachelor’s degree in health or business administration, economics or related subject is required. Master’s preferred.