Manager, Payor Contract Services

UPMC; Pittsburgh (Allegheny County); Hybrid; USD 120.000 - 180.000; Vollzeit

Zusammenfassung

UPMC is seeking a Manager, Payor Contract Services to lead contract planning, review, and negotiations across ambulatory and ancillary service lines. The role requires strategic leadership in reimbursement initiatives and operational support for diverse provider types, including IDTFs, urgent care, ASCs, infusion centers, and home health services.

The manager will review opportunities, represent UPMC with payors, coordinate meetings, and develop contract plans to grow market share.

Qualifikationen

• Bachelor's or Master's with required experience in payor contracting.
• Experience negotiating commercial, Medicare and Medicaid agreements.
• Strong understanding of healthcare reimbursement methodologies.
• Ability to lead Payor Contract Services staff and cross-functional teams.

Aufgaben

• Review and evaluate commercial, Medicare, and Medicaid contract opportunities; assess risks and benefits for UPMC.
• Act as primary representative with payors; coordinate meetings; analyze changes in terms.
• Communicate with Hospital/Physician divisions, Joint Venture Partners, and Patient Billing Services about terms and rates.

Kenntnisse

Contract negotiation

Leadership

Strategic planning

Communication

Ausbildung

Bachelor's degree + 10+ years experience

Master's degree + 7+ years experience

Jobbeschreibung

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.

• Bachelors Degree in Business Administration, Accounting, Health Care Management, Information Systems, or a quantitative field of study (i.e., mathematics, economics, sciences, finance, etc.) with a minimum of ten years relevant experience.

• OR Master Degree in Business Administration, Health Care Management, Information Systems or a quantitative field of study (i.e., mathematics, economics, sciences, finance, etc.) with seven years experience will be considered

• Demonstrated experience negotiating commercial, Medicare and Medicaid managed care agreements and rates for freestanding/ancillary providers

• Strong understanding of free standing healthcare reimbursement methodologies and contracting principles

Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran