Director, Payer Strategy & Value-Based Contracts

careers-centralhealth; Kramer (ND); On-site; USD 150,000 - 230,000; Full time

Job summary

Central Health System is seeking a Director of Payer Strategy & Contracting to lead negotiation, implementation, and ongoing management of payer agreements across Medicaid, Medicare, MCOs, and commercial payers.

The role partners with executive leadership and analytics teams to evaluate performance, model financial scenarios, mitigate risk, and drive continuous improvement in reimbursement strategy and contract operations. Strong leadership and healthcare contracting experience required.

Qualifications

• Bachelor's degree in Business, Healthcare Administration, Finance, or related field.
• 7 years of progressive experience in payer contracting within healthcare.
• Proven experience negotiating with Medicaid, Medicare, MCOs, and commercial payers.
• Experience structuring, implementing, or managing value-based care arrangements or alternative payment models.

Responsibilities

• Leads payer contracting strategy, negotiations, renewals, amendments, and escalations with Medicaid, Medicare, Managed Care Organizations, and commercial payers.
• Develops contracting strategies that support organizational priorities, strengthen payer partnerships, maximize reimbursement, and promote financial sustainability.
• Evaluates contract terms related to reimbursement methodologies, payment policies, quality requirements, performance expectations, reporting obligations, and operational impacts.
• Leads rate negotiations and recommends contract structures that support both financial and operational goals.
• Ensures payer agreements are reviewed for alignment with applicable federal, state, and program-specific requirements.
• Designs, negotiates, implements, and monitors value-based care arrangements, including shared savings, pay-for-performance, quality incentive, bundled payment, capitation, and other models.
• Develops payer proposals for value-based or alternative payment arrangements based on organizational strategy, data analysis, financial modeling, operational readiness, and risk tolerance.
• Partners with population health, quality, finance, clinical operations, and analytics teams to model risk corridors, attribution methodologies, benchmark methodologies, performance measures, and projected financial impact.
• Monitors value-based care performance, including quality metrics, cost performance, utilization trends, incentive payment projections, and related payer reporting requirements.
• Partners with Finance to evaluate contract terms, forecast expected revenue, assess reimbursement performance, and identify potential financial risk exposure.
• Uses data and analytics to identify underperformance trends, reimbursement gaps, payer payment issues, and opportunities for improvement.
• Supports cost modeling, contract performance dashboards, financial impact assessments, and executive-level reporting related to payer contract performance.
• Prepares and presents contract performance updates, recommendations, and executive briefings to support informed decision-making.
• Serves as a primary liaison with external payer contracting teams and supports productive, collaborative payer relationships.
• Leads cross-functional governance related to payer performance, contract implementation, reimbursement issues, and operational barriers.
• Coordinates with Revenue Cycle, Finance, Compliance, Clinical Operations, Population Health, and other internal stakeholders to ensure contract terms are implemented and operationalized effectively.
• Provides internal education and guidance regarding payer contract terms, reimbursement methodologies, payment policies, and operational requirements.
• Collaborates with revenue cycle teams to resolve payer payment issues, denials, reimbursement disputes, and other contract-related operational concerns.
• Provides leadership and oversight for payer enrollment activities, including applications, revalidations, enrollment maintenance, and related payer requirements.
• Manages the Payer Enrollment Specialist and ensures payer enrollment processes support organizational access, reimbursement, compliance, and operational needs.
• Ensures payer enrollment activities are coordinated across applicable locations, providers, and payer programs.
• Ensures payer agreements align with applicable federal and state regulations, including Medicaid managed care requirements, Medicare guidelines, value-based care reporting requirements, and other payer-specific obligations.
• Ensures appropriate alignment of payer contracts with FQHC reimbursement methodologies and applicable grant, funding, or program requirements, where applicable.
• Maintains accurate payer contract files, rate schedules, payer documentation, and related regulatory records.
• Supports audits, regulatory reviews, payer inquiries, and compliance-related requests as needed.

Education

Bachelor's Degree in Business, Healthcare Administration, Finance, or related field

Job description

Central Health System is seeking a Director of Payer Strategy & Contracting to lead negotiation, implementation, and ongoing management of payer agreements across Medicaid, Medicare, MCOs, and commercial payers.

The role partners with executive leadership and analytics teams to evaluate performance, model financial scenarios, mitigate risk, and drive continuous improvement in reimbursement strategy and contract operations. Strong leadership and healthcare contracting experience required.