Under the general direction of the Vice President-Finance-Population Health & Payor Contracting, and in conjunction with objectives set by the Senior Vice-President Finance and System Care Contracting Team, is responsible for all aspects of maintaining and managing payor relationships on behalf of WellSpan Health, as well as managing operational aspects of quality pay for performance contracts. Responsible for operational management of the WellSpan System contracts, which includes supporting other functional areas that deal directly with payors. Oversees the Payor Contracting Analysts. In helping to accomplish strategic goals, this position is a member of the WellSpan s System Care Contracting Team as well as participates in a variety of financial projects.
Duties and Responsibilities:
1 Selects staff, trains/orients personnel, evaluates performance, prepares work schedules and makes recommendations for personnel actions.
2 Manages existing payor relationships on all contracts including handling of all operating issues related to patient and administration concerns while identifying root causes and process improvement initiatives.
3 Manages payor relationships, integrating contract changes into appropriate clinical areas and managing payor issues with periodic payor meetings.
4 Tracks quality/pay for performance programs (e. g. Highmark quality programs) for the WellSpan System.
5 Manages all Wellspan System payor policy changes through communication with all applicable departments.
6 Manages contractual notification requirements as defined by contract language for new service additions to the WellSpan Health delivery system.
7 Maintains a strong knowledge of all pertinent governmental regulations that pertain to both payor contracts and hospital operations (i. e. Act 68, HIPAA) ensuring appropriate compliance requirements are kept by departmental personnel as applicable
8 Participates in interdepartmental meetings (i. e. CCT, UM, RCM Committee) to coordinate improvement in the hospital's revenue cycle.
9 Looks for ways to improve operational and/or financial efficiency of the hospital resulting in financial savings.
10 Assists the VP of Payor Contracting and Population Health in financial analysis and/or other projects
Ideally candidate has experience:
Handling health care billing or worked in insurance, dealt with providers from pay relations perspective.
Ability to resolve conflicts between parties