Director Payor Contracting

Valley Children's Healthcare; California; On-site; USD 120,000 - 168,000; Full time

Job summary

Valley Children's Healthcare is seeking a Director of Payor Contracting to lead and coordinate payor contracting efforts across hospital and medical groups. You will negotiate contracts, manage payer relationships, and provide strategic analysis and executive-level decision support.

Candidates should have 5+ years in payor contracting, strong leadership, and knowledge of managed care in a hospital setting. This full-time role is based in California with 40 hours weekly and 100% FTE.

Qualifications

• Minimum five (5) years Related field with five years of related work experience (required)
• Minimum two (2) years Managerial experience (preferred)

Responsibilities

• Coordinate and execute payor contracting strategies for Valley Children's Healthcare.
• Negotiate hospital, medical group and primary care contracts; maintain productive payer relationships; provide executive-level decision support.

Education

College Degree - 4 year Related field/discipline

Masters Degree Related field/discipline

Job description

About Us

Revenue Cycle Management (RCM) is the patient-centric, comprehensive process of managing the financial aspects of patient care from initial appointment scheduling and patient registration to the final payment of medical bills. Effective RCM ensures that our healthcare system receives timely and accurate reimbursement for services rendered, maintains compliance with regulations, and enhances operational efficiency, ultimately supporting the financial stability of the organization and improving the overall patient experience.

The Revenue Cycle Division consists of many departments including Patient Scheduling Center, Admissions, Financial Counseling, Clinical Documentation Improvement, Coding, ED Registration, Health Information Services, Outpatient Services Funding, Patient Accounting, Patient Financial Services, Payor Contracting and Revenue Integrity. Some departments have a full complement of staff onsite, others operate on a hybrid model while some staff work entirely from home.

Our team consists of a diverse group of skilled professionals, all working together to optimize patient and family engagement through a positive financial experience.

Job Summary

The Director, Payor Contracting reports directly to the Vice President Revenue Cycle and Managed Care and is responsible for coordinating and executing payor contracting strategies. This position is responsible for the negotiation and management of payor contracts that meet the financial, operational, and strategic goals of Valley Children's Healthcare. The director is responsible for developing and maintaining productive payor relationships; negotiating hospital, medical group and primary care contracts; and ensuring contract performance goals are met. This position acts as the primary lead for all payer relations at Valley Children's Healthcare. This position directs analysis and reporting for managed care strategies, as well as, executive-level decision support.
Must have a broad-based knowledge of hospital and medical group operations. Must maintain expert knowledge of the managed care industry and its application in a hospital setting. Must have knowledge of hospital and medical group contract management and financial information systems.

Qualifications

Education

• College Degree - 4 year Related field/discipline (required)
• Masters Degree Related field/discipline (preferred)

Work Experience

• Minimum five (5) years Related field with five years of related work experience (required)
• Minimum two (2) years Managerial experience (preferred)

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Compensation Range

$87.10 - $121.95

Workshift

Day (United States of America)

Position Exempt

Yes

FTE %

100

Scheduled Weekly Hours

40

Daily Hours

8

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Disclaimer: Final compensation will be dependent upon skills and experience.