Overview
Director of Payor Strategy & Contracting
Hours : Full-time; 40 hours per week within normal business hours.
Location : Downers Grove, IL 60515
Benefits :
- Comprehensive medical and prescription drug benefits that include medical coverage at 100% (after deductible) when utilizing a Duly provider.
- 5,250 Tuition Reimbursement per year.
- 40 hours paid volunteer time off.
- A culture committed to Diversity, Equity, and Inclusion (DEI) and Social Impact
- 12 Weeks parental leave at 100% pay and a financial benefit for adoption and surrogacy for non-physician team members.
- 401(k) Match
- Profit-sharing program
This individual will be responsible for evaluating contracting opportunities, negotiating financial and contract language terms, and developing viable partnerships with payors and providers. The role has responsibility developing and maintaining strong productive relations to support the strategic objectives of Duly / SBC / QMG and future entities which contribute to viable strategic partnerships that optimize contract performance.
Responsibilities
Identify, explore, and evaluate all contracting and renegotiation opportunities for alignment with Duly strategic objectivesNegotiate financial and contractual language with payers to optimize favorable contract performanceDevelop and execute payor specific negotiation strategies. Deploy various contracting and reimbursement methodologies (FFS, VBC, capitation) as warranted and appropriately leverage the capabilities of the organization to achieve a favorable negotiation outcomeMaximize value-based care contracting mechanisms including opportunities for full risk, pay for performance and shared risk incentives in collaboration with VBC team.Manage accountable care organizations payor partnerships and downstream relationships to optimize ACO performance and coordinate with payers on gaps, issues and barriers.Work closely with finance and analytics team to model potential contract financial terms and monitor contract performanceEvaluate and renegotiate existing contracts for improved contractual performanceWork with RCM, VBC, Finance and clinical operations team to successfully implement contract termsMaintain and develop payor and provider relationships to ensure long term success of all contractual partnerships including participation in joint operating committees to promote contract optimizationFacilitate the transition of payor contracts for new practices and / or services to ensure alignment with strategic initiatives and optimal reimbursement.Qualifications
Bachelor's degree required, Master's degree preferred in Business, Finance, Healthcare Administration, or related10-12 years of experience with managed care contract negotiations at the payor level with experience negotiating and operationalizing value-based care contracting arrangements including Accountable Care Organizations3+ years leadership experience requiredAbility to successfully manage change and lead a team through changeStrong interpersonal skills with the ability to interface with senior leadership internally and externally.Excellent negotiation and financial skillsExcellent contract management skills including depth in optimizing contract terms, tracking critical negotiation communications / changes and mitigating contract language risks,Ability to build relationships with others and identify and turnaround potential deteriorating relationships to foster strategic partnershipsIn depth understanding of healthcare administration, managed care and value-based care.Required knowledge of Microsoft office including superior excel skillsThe compensation for this role includes a base pay range of $125K-$188K, with the actual pay determined by factors such as skills, experience, education, certifications, geographic location, and internal equity. Additional compensation may be available through shift differentials, bonuses, and other incentives. Base pay is only a portion of the total rewards package.
