Manager of Payor and Market Strategy

Days - Full Time

Southlake Campus

Position Summary / Career Interest:

The Manager of Payor and Market Strategy, under the supervision of the Director of Managed Care, is responsible for the negotiation or renegotiation contracts with managed care companies and health plans which accounts for 70% of the health system revenues. This position enhances our managed care program by analyzing contract opportunities to increase or maintain market share and develop strategies for different product and relationships. The negotiation role includes developing, evaluating and responding to rate structures and rate levels for all services and locations across UKHS including but not limited to, hospital inpatient and outpatient services, ambulatory surgery center, physicians, transplant services, behavioral health, home infusion, and other professional services. This position will have responsibility regarding managed care contracting, internal and external payer related relations, and contracting support.

Responsibilities and Essential Job Functions

• Must be able to perform the professional, clinical and or technical competencies of the assigned unit or department. Negotiation
• Assist in the development of the negotiations and renegotiations strategy of the managed care contracts to achieve the overall goals of the health system.
• Report market opportunities and monitor significant changes to protect and enhance market share for the health system.
• Educate and assist in the development of varying contract structures for reimbursement including full range of hospital, physician, ASC, bundled, value based, capitative or others to other key internal departments.
• Analyze contract requirements, special provisions, terms and conditions to ensure compliance with appropriate laws, regulations and UKHS policies and procedures.  Seek director and legal input when necessary.
• Analyze rates of proposals and counterproposals using various contract modeling tools including but not limited to EPIC contract modeling, Excel, and Access.
• Meet with health plans and payers including development of key agenda items and preparation for negotiations, as well as joint operating committee meetings.
• Ensure contract language terms meet the needs of the health system financially and operationally, work collaboratively with the director and legal counsel to ensure regulation terms are compliant.
• Monitor contract performance and other provisions to ensure compliance, identify potential problem areas and help internal staff resolve disputes.
• Coordinate with the contracting team on behalf of all the entities.
• Ongoing analysis of existing contracts for compliance and performance
• Analyze historical utilization and trends in revenues, by reviewing financial data reports to identify issues with operations of contracts.
• Update directors of contracting on unexpected changes in the planned performance of contracts.
• Engages payers to ensure that UKHS is not excluded or disadvantaged as payers adapt or change their plans and implement policies and/or procedures.
• Develop standard reports and maintain skills for ad hoc reports
• Assist with reporting needs for budget purposes, revenue projections and long-range planning.
• Serve as liaison with Revenue Cycle and other operational departments
• Address operational issues with payers by proactively identifying issues, and soliciting information and feedback from Revenue Cycle regarding implementation and performance of contracts
• Provide ongoing assistance in processes, communication and interpretation of the language and intent of the contracts.
• Stay abreast of the changes in the insurance and payer market.  Be knowledgeable and available as a resource for staff for issues and concerns.
• Responsible for the maintenance of the managed care contracts.
• Maintain skills in EPIC, payer portals, Excel and any other reporting tools for building expected reimbursement models.
• Develop and maintain reports to monitor contract compliance with expected reimbursement
• Interact with Revenue Cycle and HITS staff on improvements and maintenance of EPIC contracts.
• Timely updates on renewals, amendments and other contract changes that need to be communicated and dissemination of the information to the appropriate audience.
• Credentialing and re-credentialing for facility and other professional services.
• Establish and maintain effective working relationships with physicians, department administrators, health plans, senior leaders, clinical operations and other internal and external staff involved in the contracting process.
• Participate in committees and related work groups as needed.
• Attend team meetings and participate in discussions and strategic initiatives.
• Supports Strategic Healthcare Solutions (UKHS) with recruitment and business development efforts by:
• Facilitate the onboarding and implementation of varying purchased services ensuring excellent communication and execution;
• Effectively communicate with prospective hospital CEO’s and CFO’s by marketing the SHS value proposition including the benefits of being aligned with the University of Kansas Health System;
• Partner with business leads on resolving customer concerns or questions;
• Assist with the integration of new service offerings into the daily operations; and,
• Build and sustain effective relationships with internal and external stakeholders; including but not limited to executive leaders and external partners.
• Manage value-based initiatives within the health system
• Analyze and evaluate population, quality and efficiency data to determine level of performance in current and future proposed value-based models.
• Work collaboratively with varying ambulatory and hospital quality teams to determine level of performance in the network and ensure quality and financial performance is meeting or exceeding established targets.
• Develop a standard reporting to provide updates on historical and projected financial outcomes for value-based initiatives.
• Serve as department liaison for contracting with payers and clinical operations team members.
• Must be able to perform the professional, clinical and or technical competencies of the assigned unit or department.
• These statements are intended to describe the essential functions of the job and are not intended to be an exhaustive list of all responsibilities. Skills and duties may vary dependent upon your department or unit. Other duties may be assigned as required.

Required Education and Experience

• Bachelors Degree in Business Administration, Healthcare Administration or similar field from an accredited college or university OR other equivalent work experience.
• 4 or more years of experience in a healthcare organization or within health industry in a financial or technical position or other equivalent work experience.

Preferred Education and Experience

• Master's Degree in Business Administration, Healthcare Administration or similar field from an accredited college or university.
• Experience in a large healthcare organization or academic medical center in managed care contracting or financial modeling/analytics.

Time Type:

Full time

Job Requisition ID:

R-56759

Important information for you to know as you apply:

• The health system is an equal employment opportunity employer.  Qualified applicants are considered for employment without regard to race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, ancestry, age, disability, veteran status, genetic information, or any other legally-protected status.  See also Diversity, Equity & Inclusion.

• The health system provides reasonable accommodations to qualified individuals with disabilities.  If you need to request reasonable accommodations for your disability as you navigate the recruitment process, please let our recruiters know by requesting an Accommodation Request form using this link [email protected].

• Employment with the health system is contingent upon, among other things, agreeing to the health-system-dispute-resolution-program.pdf and signing the agreement to the DRP.

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