Director of Payer and Provider Contracting
Great Lakes Integrated Network, Inc.
- Buffalo, NY
- $110,000-160,000 per year
- Permanent
- Full-time
- Contract Negotiation
- Lead the negotiation process for payer contracts, including fee-for-service, value-based, and alternative payment models.
- Negotiate provider contracts to ensure alignment with payer agreements and IPA objectives.
- Develop negotiation strategies to optimize reimbursement rates and contract terms.
- Contract Development and Management:
- Develop contractual agreements with payers and providers, ensuring compliance with regulatory requirements and ACO policies.
- Collaborate with legal and compliance teams to review, finalize, and execute contracts.
- Monitor contract performance and compliance, identifying opportunities for improvement or renegotiation.
- Relationship Management:
- Cultivate and maintain strong relationships with payer organizations, including health insurance companies, government payers, and other stakeholders.
- Collaborate with internal departments, including finance, analytics, operations, legal, compliance, and clinical teams, to align contracting strategies with organizational goals.
- Serve as the primary point of contact for payer and provider inquiries, escalations, and dispute resolution.
- Market Analysis and Strategy:
- Conduct market analysis to identify payer and provider trends, competitive landscape, and opportunities for partnership.
- Develop strategic initiatives to expand the IPA's network, increase market share, and improve financial performance.
- Monitor industry changes and regulatory developments to inform contracting strategies and risk mitigation.
- Performance Evaluation and Reporting:
- Evaluate contract performance metrics, including reimbursement rates, utilization, and quality outcomes.
- Prepare and present reports on contract performance to executive leadership and relevant stakeholders.
- Recommend adjustments to contracting strategies based on performance analysis and market dynamics.
- Other duties as assigned
- Education: Baccalaureate degree in business, economics, finance, or related field
- Minimum of 5 years’ experience in healthcare contracting/analytics/network management
- Minimum of 2 years’ experience managing people, teams, and processes
- An understanding and application of medical billing and reimbursement procedures/practices
- An understanding of proper negotiation techniques
- Excellent communication skills, including presentation of complex topics, written and oral communication skills
- Strategic mindset, with the ability to develop and execute contracting strategies aligned with organizational objectives
- Ability to work independently in a fast-paced environment
- Ability to interact with management personnel and the provider community
- Possess strong organizational skills and attention to detail
- Ability to multi-task and meet multiple deadlines
- Adaptive and flexible to new ideas and change
- Strong supervisory and leadership skills
- Excellent interpersonal and negotiation skills
- Strong analytical and problem-solving skills
- Ability to adapt to the needs of the organization and employees
- Proven ability to prioritize tasks and to delegate them when appropriate
- Proficient with Microsoft Office Suite or related software