Director Payer Contract/Credentialing (Managed Care Dept) Position Available In Miami-Dade, Florida

Job Description:

Remote Candidates Welcome to ApplyJob SummaryResponsible fortechnical and professional payer contracting, credentialing, andpricing for the entire Health System. Provide guidance and supportto Senior Leadership in aspects of payer contracting/negotiations,pricing, and delegated credentialing for the Health System.

Responsible for pivoting and adapting NCHS to an everchanging payerlandscape and reimbursement structure. Be a role model and leaderto subordinates and develop a strong educated and impactful teambench.

Job Specific Duties Responsible for detailed understanding of health care industry,market dynamics, trends, competitors, regulations, and payerenvironment. Collaborates with the management team and all departmentallevels on both the hospital and physician sides. Ensure operationalissues are addressed and remedied through negotiation, projectplanning, or contract modification. Creates and maintains professional relationships with payersand potential affiliates. Creates, analyzes, and interprets financial reports to supportpayer negotiations, trends, and audit. Implements and communicates contracting strategies incollaboration with Senior Leader. Manages all out of network contracting for both hospital andemployed physicians. Responsible for the management and development ofsubordinates. Knowledge and willingness to support new value-basedtransformational contracting strategy at the right time in theright setting. Provides direction, feedback, and recommendations on trendedpayer performance; serves as the SME for all payer relatedcontractual arrangements/issues- current and historical. Responsible for overseeing the management of all in network andout of network contracting and negotiations for the hospital andemployed physician group. Responsible for making high impact decisions steeped injudgment. Develop and lead Joint Operating Committee meeting with payersand respective NCHS departments. Complies with legal and regulatory compliancerequirements. Leads and oversees Corporate Pricing function. Leads and oversees Corporate Credentialingfunction.

QualificationsMinimum Job Requirements Bachelor’s Degree in Business Administration or HealthManagement 4-7 years of management experience in the healthcarefinance/payer/managed care contracting field 7-10 years of hospital and/or payer negotiations and analysisexperienceKnowledge, Skills, and Abilities MBA or MHA preferred. Work well under immense pressure with an ability to focus onmultiple priorities while maintaining focus, attention to detail,and connecting all the dots. Demonstrated leadership progression. Knowledge of fee for volume and fee for value reimbursementmethods. Strong contract review and interpretation skills. Familiarity working with Lawyers and interpreting statutes andregulations. Business acumen and strong financial skills. Excellent written, oral, and communications skills. Success in persuasion, influence, and negotiation skills. Management expertise, strong knowledge of data analysis, andstatistics. Able to handle day to day administrative routine, as well as,constantly changing, competing projects, urgent situations,sometimes simultaneously. Able to relate cooperatively and constructively with payers andco-workers. Effective communicator with a strong, transparent, and clearstyle; ability to deliver tough messages with tact. Effectively monitor and develop the abilities ofsubordinates. Able to maintain confidentiality of sensitive information. Knowledge of payer and hospital credentialing function. Ability to interpret, adapt, and react calmly under stressfulconditions. Ability to analyze and interpret complex models and apply tobusiness ask; strong spreadsheet skills. Ability to use logical & scientific thinking to interprettechnical data and solve a broad range of problems. Able to relate cooperatively and constructively with medicalstaff, executives, staff, elected officials, and managed carecompanies.

Job:

ManagementPrimary Location:

Florida-Miami-NCHSCorporate HeadquartersDepartment:

NCHS-MANAGED

CARECONTRACTING-1000-900910

Job Status:

Full Time #J-18808-Ljbffr