What are the responsibilities and job description for the Director Payer Contract/Credentialing (Managed Care Dept) position at Nicklaushealth?
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Job Summary
Responsible for technical and professional payer contracting, credentialing, and pricing for the entire Health System. Provide guidance and support to Senior Leadership in aspects of payer contracting / negotiations, pricing, and delegated credentialing for the Health System. Responsible for pivoting and adapting NCHS to an everchanging payer landscape and reimbursement structure. Be a role model and leader to subordinates and develop a strong educated and impactful team bench.
Job Specific Duties
- Responsible for detailed understanding of health care industry, market dynamics, trends, competitors, regulations, and payer environment.
- Collaborates with the management team and all departmental levels on both the hospital and physician sides. Ensure operational issues are addressed and remedied through negotiation, project planning, or contract modification.
- Creates and maintains professional relationships with payers and potential affiliates.
- Creates, analyzes, and interprets financial reports to support payer negotiations, trends, and audit.
- Implements and communicates contracting strategies in collaboration with Senior Leader.
- Manages all out of network contracting for both hospital and employed physicians.
- Responsible for the management and development of subordinates.
- Knowledge and willingness to support new value based transformational contracting strategy at the right time in the right setting.
- Provides direction, feedback, and recommendations on trended payer performance; serves as the SME for all payer related contractual arrangements / issues- current and historical.
- Responsible for overseeing the management of all in network and out of network contracting and negotiations for the hospital and employed physician group.
- Responsible for making high impact decisions steeped in judgment.
- Develop and lead Joint Operating Committee meeting with payers and respective NCHS departments.
- Complies with legal and regulatory compliance requirements.
- Leads and oversees Corporate Pricing function.
- Leads and oversees Corporate Credentialing function.
Qualifications
Minimum Job Requirements
Knowledge, Skills, and Abilities
Job : Management
Primary Location : Florida-Miami-NCHS Corporate Headquarters
Department : NCHS-MANAGED CARE CONTRACTING-1000-900910
Job Status : Full Time
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