What are the responsibilities and job description for the Director, Payer Contracting - La Jolla position at Scripps Health?
Director position is eligible for new hire incentives and participates in the Director Incentive Plan.
Located in La Jolla, San Diego and requires you to be a resident of San Diego County.
Why join Scripps Health?AWARD-WINNING WORKPLACE:
- Becker's 150 Top Places to Work in Healthcare
- Nearly a quarter of our employees have been with Scripps Health for over 10 years.
The Payer Relations team is a close-knit group of highly motivated individuals. We are passionate about our work and love to laugh.
What will you do?- Negotiate fee-for-service, partial risk, and full global risk HMO, PPO, and Ancillary services managed care agreements with health plans on behalf of Scripps Health's hospitals/facilities or Scripps Medical Foundation and partner medical groups or a combination of both in order to achieve Scripps Health's revenue targets and overall goals.
- Oversee and actively engage in the analysis, management, accounting, and budgeting of all managed care agreements. Establish effective lines of communication between Payer Relations and Patient Financial Services, Business Services, and Scripps Health Plan Services in order to maximize contract effectiveness and ease of administration.
- Negotiate settlements and resolve disputes between Scripps Health, Scripps Health Plan Services, and third-party payers.
- Present the results to all levels of management at Scripps Health and Scripps Health Plan Services in order to support its negotiating position.
- Communicate with health plans upon acquisition of hospitals, ancillary facilities, and medical groups in order to include them in HMO, PPO, and Ancillary services managed care agreements.
- Participate in strategy development for Scripps Health/Scripps Health Plan Services payer contracting.
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Required Education/Experience/Specialized Skills:
- Bachelor's degree plus five (5) years of management experience in hospital and medical group fee-for-service, partial risk, and full global risk HMO, PPO, and ancillary services negotiations and contracting experience, including strong knowledge of legal and financial issues.
Preferred Education/Experience/Specialized Skills/Certification:
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Master's degree in business or health care administration, or a related field, and eight (8) years of hospital and medical group fee-for-service, partial risk, and full global risk HMO, PPO, and ancillary services negotiations and contracting experience.
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Strong financial modeling and analytic skills and experience overseeing this function in a multi-institutional/medical group setting.
Scripps Health is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, age, status as a protected veteran, among other things, or status as a qualified individual with disability.
