Director Payor Contracting

LE01 Valley Children's Hospital; United States; 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 optimize payer contracting strategies. You will negotiate hospital, medical group, and primary care contracts, manage relationships with payors, and provide analysis and decision support for managed care initiatives.

The role reports to the Vice President of Revenue Cycle and requires broad knowledge of hospital operations and the managed care landscape.

Qualifications

• Minimum five (5) years related field experience.
• Minimum two (2) years managerial experience (preferred).

Responsibilities

Skills

Experience 5 years

Managerial experience

Education

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

Masters Degree Related field/discipline (preferred)

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.

Valley Children’s Healthcare – one of the largest pediatric healthcare networks in the nation – provides Central California’s only high-quality, comprehensive care exclusively for children, from before birth to young adulthood. With more than 670 physicians and 3,500 staff, Valley Children’s delivers high-quality, comprehensive care to more than 1.3 million children in our service area. Our network offers highly specialized medical and surgical services to care for children with conditions ranging from common to the highly complex at our 358-bed stand-alone children’s hospital that includes 28 regional NICU beds. Our family-centered, pediatric services extend from a leading pediatric cancer and blood disorders center home on the West Coast, and a pediatric heart center known for its expertise and pioneering treatments, to a Regional Level IV neonatal intensive care unit (NICU), the highest level referral center between Los Angeles and the Bay Area. We participate in community initiatives, we support community efforts, we get involved where we can do the most good.

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.

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.

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)

Compensation and Work Details

Compensation Range: $87.10 - $121.95

Workshift: Day (United States of America)

Position Exempt: Yes

FTE %: 100

Scheduled Weekly Hours: 40

Daily Hours: 8

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