Manager, Payor Contract Services

UPMC; Pittsburgh (Allegheny County); Hybrid; USD 120,000 - 150,000; Full time

Job summary

UPMC Payor Contract Services invites a Manager to lead contract strategy across Ambulatory/Ancillary services. The role directs planning, negotiation and management of commercial, Medicare and Medicaid agreements, with focus on reimbursement terms and policy development. Hybrid work environment.

The manager will coordinate with Hospital and Physician divisions, Joint Venture Partners and Patient Billing Services to align terms, ensure timely changes, and strengthen UPMC's market position.

Responsibilities

• Review and evaluate commercial, Medicare and Medicaid contracts; assess terms and reimbursement; advise Director and others.
• Act as UPMC's primary representative with payors and UPMC entities; resolve issues and coordinate meetings.
• Review and analyze significant changes in contractual terms with current and potential payers.
• Assist Director in developing contract plans and payer strategies.
• Seek new opportunities to enhance UPMC market share or reimbursement through payor agreements.
• Develop Policies and Procedures related to departmental functions.

Job description

Our UPMC Payor Contract Services Team has an exciting opportunity available as a Manager, Payor Contract Services! This full-time position offers a hybrid work environment.

In this role, the Manager is responsible for the planning, review, negotiation and management of agreements within the Ambulatory/Ancillary service line.They provide strategic leadership for contract negotiations, reimbursement initiatives, and operational support across a broad range of provider types, including but not limited to Independent Diagnostic Testing Facilities, Urgent Cares, Ambulatory Surgical Centers, Infusion Centers, Home Infusion, Skilled Nursing, Home Health, Rehabilitation Centers.

Responsibilities:

• The review and evaluation of all commercial, Medicare and Medicaid contract opportunities, including both language and reimbursement terms and offer recommendations to the Director and others within UPMC as appropriate. Must be able to identify risks and benefits to UPMC.
• Act as UPMC's primary representative with payors and UPMC entities. Resolve issues between UPMC and payors as necessary. Coordinate meetings between the parties as necessary. Review and analyze significant changes in contractual terms with current contracted payers and potential contract payers.
• Communicates with other UPMC areas including Hospital and Physician division, Joint Venture Partners, Patient Billing Services regarding contract terms and rates and the timely notification of changes in those terms and rates.
• Assist the Director of Payor Contract Services in the development of the UPMC contract plans and strategies for individual payers and overall for UPMC. Seeks new opportunities for enhancing UPMC market share or reimbursement through payor agreements or relationships.
• Develop Policies and Procedures related to departmental functions as appropriate.
• Manage and provide direction to Payor Contract Services staff.