Director Payer Contract/Ops/Credentialing

Nicklaus Children's; Miami (FL); On-site; USD 170,000 - 260,000; Full time

Job summary

Nicklaus Children's seeks a Director Payer Contract/Ops/Credentialing to lead all payer contracting and credentialing across the Health System in Miami, FL. You will guide senior leadership on pricing, negotiations, and delegated credentialing, building a strong team and ensuring regulatory compliance while adapting to a changing payer landscape.

This role requires strategic vision and hands-on leadership of a talented work force.

Qualifications

• Bachelor's Degree in Business Administration or Health Management
• 7-10 years of management experience in the finance/analytics/accounting field- healthcare related.
• 7-10 years of hospital or payer contracting and negotiating experience.

Responsibilities

• Oversee payer contracting and credentialing for the Health System.
• Collaborate with senior leadership to shape pricing and negotiations.
• Lead the Credentialing function and manage subordinates.
• Develop contracting strategies with payers and affiliates.
• Ensure compliance with legal and regulatory requirements.
• Mentor and develop team, monitor performance and training.
• Communicate payer strategy and performance to executives.
• Manage in-network and out-of-network contracting for hospital and physicians.

Skills

Leadership

Strategic thinking

Negotiation

Financial analysis

Communication

Project management

Microsoft Excel

Education

Bachelor's degree in Business Administration or Health Management

Tools

Microsoft Excel

Job description

Job Description - Director Payer Contract/Ops/Credentialing (302255)

Job Description

Director Payer Contract/Ops/Credentialing - 302255

Description

Job Summary

Responsible for technical and professional payer contracting and credentialing for the entire Health System. Provides 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 direct reports 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 contracting strategies and approaches. Innovative and out of box thinker
• 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 Credentialing function.

Qualifications

• Bachelor's Degree in Business Administration or Health Management
• 7-10 years of management experience in the finance/analytics/accounting field- healthcare related.
• 7-10 years of hospital or payer contracting and negotiating experience.

Knowledge, Skills, and Abilities

• MBA, MHA, and or JD preferred.
• Work well under immense pressure with an ability to focus on multiple priorities while maintaining focus, attention to detail, and connecting all the dots.
• Demonstrated leadership progression.
• Knowledge of Governmental and Commercial payer fee for volume and fee for value reimbursement methods.
• Strong analytical and contract language interpretation skills.
• Familiarity working with Lawyers and interpreting statutes and regulations.
• Business acumen and strong financial skills.
• Excellent written, oral, and communications skills.
• Success in persuasion, influence, and negotiation skills.
• Management expertise, strong knowledge of data analysis, and statistics.
• Able to handle day to day administrative routine, as well as, constantly changing, competing projects, urgent situations, sometimes simultaneously.
• Able to relate cooperatively and constructively with payers and co-workers.
• Effective communicator with a strong, transparent, and clear style; ability to deliver tough messages with tact.
• Effectively monitor and develop the abilities of subordinates.
• Able to maintain confidentiality of sensitive information.
• Knowledge of payer and hospital credentialing function.
• Ability to interpret, adapt, and react calmly under stressful conditions.
• Ability to analyze and interpret complex models and apply to business ask; strong spreadsheet skills.
• Ability to use logical & scientific thinking to interpret technical data and solve a broad range of problems.
• Able to relate cooperatively and constructively with medical staff, executives, staff, elected officials, and managed care companies.
• Independent and self starter with exceptional judgement and time management skills

Job

Management

Department

NCHS-MANAGED CARE CONTRACTING-1000-900910