What are the responsibilities and job description for the Director, Payer Contracting position at Patient First?
The responsibilities of this job include, but are not limited to the following :
- Fostering productive relationships with third-party commercial and government payers in new and renewing contract negotiations in all states where Patient First provides services;
- Collaborating with the data analytics team and providing direction regarding proposed contract modeling and all related assumptions;
- Maintaining relationships with and engaging in ongoing external discussions with third parties in the best interests of Patient First (e.g., state insurance departments, state Medicaid agencies, state medical societies, state MGMAs, Virginia Center for Health Innovation, etc.);
- Facilitating weekly meetings to report on contract negotiation statuses and discussing strategies, action plans, timelines, and team accountabilities;
- Overseeing the tracking, budgeting, and renewal of existing payer agreements and amendments in a timely manner. This includes quantifying opportunities and potential deal value;
- Working with the CFO and Controller on high-level reimbursement forecasting and budgeting scenario modeling. Supporting the annual revenue budget process by forecasting rate increases across all lines of business;
- Assessing public policy changes for their impact on Patient First (e.g. federal, state, CMS, CMMI, CDC, etc.);
- Reviewing contract language and working with the Legal Department to ensure contract compliance with Patient First policies;
- Reviewing payer contract amendments personally and ensuring they are also properly reviewed by internal departments and addressed in a timely manner (escalating significant issues to senior leadership as appropriate);
- Assisting and advising the Payer Relations and Value-Based Care team regarding various reimbursement and operational aspects of proposed third-party contracts;
- Serving as a company resource on contract issues and interpretations as well as a mentor to others regarding contract negotiation and reimbursement tactics;
- Working closely with the contract implementation team (consisting of multiple departments) to address contract structure and help resolve operational setup questions;
- In conjunction with the payer operations team, communicating with payers as needed to ensure contract compliance, recover reimbursement, address ongoing contract operations, and serve as an additional liaison with payer counterparts;
- Collaborating with the Director of Payer Operations to determine areas of focus for the reimbursement audit team;
- Meeting with payers face-to-face annually to foster strong relationships when possible. Attending, supporting, and potentially facilitating meetings between Patient First senior leadership and their payer counterparts;
- Participating in various internal committee meetings to solve multi-disciplinary issues;
- Serving as Management Information Systems (MIS) liaison for Payer Contracting issues requiring programming solutions;
- Researching, analyzing, and completing projects;
- Attending meetings with the Payer Relations and Value-Based Care team as directed;
- Occasional travel required.
Minimum education and professional requirements include, but are not limited to, the following :
