Director, Payer Relations/Pricing

Diversityminnesota; Minneapolis (MN); On-site; USD 120,000 - 160,000; Full time

Job summary

A leading pediatric health system in Minnesota seeks a strategic leader to oversee payer engagements and contracting processes. This role requires extensive experience in healthcare financial management and a strong understanding of value-based care models. The ideal candidate will have a proven track record of success in similar roles and the ability to lead and build effective teams.

Benefits

Medical Benefits

Dental Benefits

Vision Benefits

Retirement Benefits

Qualifications

• At least 10 years of healthcare financial/managed care supervisory experience.
• Direct experience with advanced reimbursement models around value-based care.

Responsibilities

• Provide strategic and financial leadership for payer engagements.
• Oversee contracting and pricing processes including analytics and compliance.
• Recruit and manage staff for the Contracting Office.

Skills

Leadership

Analytical Skills

Communication

Problem Solving

Education

Bachelor's degree in healthcare

Master's degree

Job description

About Children's Minnesota

Children's Minnesota is one of the largest pediatric health systems in the United States and the only health system in Minnesota to provide care exclusively to children, from before birth through young adulthood. An independent and not-for-profit system since 1924, Children's Minnesota is one system serving kids throughout the Upper Midwest at two free-standing hospitals, nine primary care clinics, multiple specialty clinics and seven rehabilitation sites. As The Kids Experts in our region, Children's Minnesota is regularly ranked by U.S. News & World Report as a top children's hospital. Find us on Facebook @childrensminnesota or on Twitter and Instagram @childrensmn. Please visit childrensMN.org .

Children's Minnesota is proud to be recognized by Modern Healthcare as one of 2023's Top Diversity Leaders. The national honor recognizes the top diverse healthcare executives and organizations influencing public policy, care delivery, and promoting diversity, equity and inclusion in their organizations and the industry.

Department Overview

Proudly serving as Minnesota's children's hospital since 1924, Children's Hospitals and Clinics of Minnesota, is the eighth-largest pediatric health care organization in the U.S. Each year, Children's provides care through nearly 13,000 inpatient visits and more than 200,000 emergency room and other outpatient visits. An independent, not-for-profit health care provider, Children's has 319 staffed hospital beds and services available in all major pediatric specialties: emergency care; newborn and pediatric intensive care; outpatient and inpatient surgery; diagnostic services, including radiology and laboratory; and special programs in the areas of respiratory, cardiology, cancer, premature birth, adolescent development, child abuse, and epilepsy. In addition to our Minneapolis and St. Paul Campuses, Children's also includes Children's West, a pediatric care center in Minnetonka offering same-day surgery as well as diagnostic, rehabilitative, and developmental outpatient services; Children's - Roseville, an outpatient pediatric rehabilitation center; and Children's Clinics - Woodwinds, pediatric specialty clinics at the Woodwinds Health Campus in Woodbury.

Position Summary

This position is responsible for providing strategic and financial leadership to support Children's commitment to value through strategically-designed payer engagements. This position will work at the system-wide level to oversee the health system and network level contracting program and the Children's revenue management chargemaster area. This position will develop and implement the payer engagement program, including designing contracting strategies, developing payer/employer engagement approaches and partnering with internal clinical and operational leaders to align contracting approaches to clinical operations. The role will oversee and manage the entire contracting and pricing process including analytics, contract development, contract negotiations, co compliance and systems monitoring. In addition, this position will oversee and manage the entire chargemaster process including the continuous maintenance of the all the system's charge description master files with the associated coding, compliance, and pricing.

The director will determine the appropriate staffing and expertise required in the Contracting Office and recruit staff to fill in the team gaps. The team will have several direct reports.

License/Certification/Registration required: No

Education:
*Bachelor's degree in healthcare, accounting, finance, management, or related field of study required.
*Master's degree preferred.

Experience:
*At least 10 years of healthcare financial/managed care supervisory experience.
*Demonstrated track record of success in a similar role within complex integrated health system, ideally one that manages payer and reimbursement analytics and managed care contract negotiations for both the hospital and physicians.
*direct experience with advanced reimbursement models around value based, total cost of care, and managed care.
*Experience with value-based care/alternative payment model arrangements
*Demonstrated knowledge and experience working with charge description masters.
*Demonstrated competence in building and leading effective and cohesive teams.
*Demonstrated success in building and maintaining positive and effective relations between physicians, hospital leadership, and other key stakeholders.

Knowledge/Skills/Abilities:
*Strong understanding of the healthcare market and reform trends.
*Knowledge of best practices in the contracting field and come from a complex healthcare system.
*Strong hospital and physician contracting knowledge and expertise.
*Expertise in the elements of payer contracting, including fee-for-service as well as alternative payment models/core elements of value-based care arrangements
*Knowledge of hospital and professional service coding and reimbursement methodologies.
*Ability to develop and communicate strategic and tactical plans, and prioritize and organize projects to meet deadlines.
*Organization skills, interpersonal skills, and the ability to manage multiple projects simultaneously.
*Analytical and problem-solving skills; excellent verbal and written communication and presentation skills.
*Ability to build and maintain strong business relationships with internal and external clients.
*Highly detailed-oriented in terms of ensuring contracts are accurate, specific, and complete.
*Understands how to work effectively with payers and providers.
*Able to delegate, trust, and rely on staff to handle projects in a timely and capable manner.
*Proven leader with ability to motivate and mentor team to create a collaborative environment.

Physical Demands

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The posted salary represents a market competitive range based on salary survey benchmark data for similar roles in the local or national market. When determining individual pay rates, we carefully consider a wide range of factors including but not limited to market indicators for the specific role, the skills, education, training, credentials and experience of the candidate, internal equity and organizational needs.

In addition to your salary, this position may be eligible for medical, dental, vision, retirement, and other fringe benefits. Positions that require night, weekend or on-call work may be eligible for shift differentials or premium pay.

All job offers are contingent upon successful completion of an occupational health assessment, drug screen, background investigation, and compliance with the U.S. Government Form I-9, Employment Eligibility Verification.

Children's Minnesota is proud to be an equal opportunity employer whose staff is representative of its community and considers qualified applicants for open positions without regard to race, color, creed, sex, religion, national origin, sexual orientation, genetic information, gender identity or expression, age, veteran status, disability, pregnancy, citizenship status, or any other characteristic protected under applicable federal, state, or local law.