Senior Regional Payer Contract Manager

About Sound :

Sound Physicians is a leading physician partner to hospitals, health plans, physician groups, and post-acute providers seeking to transform outcomes for acute episodes of care.

For 20 years our high-performing and affordable care models have combined physician leadership, clinical process, technology and analytics to consistently improve clinical and financial performance.

We are pioneers in value, working together with our partners and community providers to bridge gaps in care, from hospital to home.

Sound Physicians offers a competitive benefits package inclusive of the items below, and more :

• Medical insurance, Dental insurance and Vision insurance
• Health care and dependent care flexible spending account
• 401(k) retirement savings plan with a company match
• Paid time off (PTO) begins accruing immediately upon start date at a rate of 15 days per year, in accordance with Sound's PTO policy
• Ten company-paid holidays per year

Position Summary

Under the strategic direction of the Director or VP, Payer Contracting the Sr. Payer Contracting Manager is responsible for all duties related to managing payer relationships, negotiations, financial modeling and tracking of new and existing payer contracts.

This position works in a matrixed manner with members of the Revenue Cycle, Business Development, Field Operations, Implementation, Financial Modeling, Payer Contracting Operations, Provider Enrollment and Value Based teams regarding contracting, financial, and strategic objectives for the assigned affecting their specific geographical region and the company.

The Sr. Payer Contracting Manager may be an individual contributor or responsible for a team of contractors and must be able to manage their time and / or their team workforce and a significant number of tasks or projects with minimal oversight.

In this role, you will be responsible for :

• Responsible for the development, coordination and analysis of managed care agreements (Commercial, Medicare, Medicaid, Exchange and Value Based) including rate development and contract negotiations while understanding key decision points and clearly presenting them for decision making.
• Responsible for the management and oversight of payer relationships in the assigned region and understands contracting and payer life cycle end to end, including contract terms and conditions, for accurate facilitation of contract implementation.

Accurate implementation of contracts

• Works with the Director and / or VP, Payer Contracting to develop and implement plans and objectives for the department in an objective and innovative fashion
• Collaborates and assist with analysis of payer mix, rate and utilization review across all service lines to determine contracting and re-contracting opportunities
• Proactively identifies, researches, understands and presents issues timely that impact Sound Physicians and partner facilities to the Director or VP, Payer Contracting
• Mentor Contracting Managers and Payer Contracting Liaisons, as needed, in all aspects of payer contracting activities
• Manage special projects as required and other duties as assigned

Knowledge :

• Minimum : Bachelor’s degree in Business, Healthcare Administration or equivalent
• Excellent commercial contract negotiation skills and experience with physician contracts
• Ability to manage multiple tasks simultaneously, meet time sensitive deadlines and organize workload with limited supervision
• Working knowledge of current policies and guidelines that affect contracts, rate development, legislative regulations etc.

in the managed care environment

• Ability to collaboratively and strategically work with Revenue Cycle, Business Development, Implementation, Field Operations, Financial Modeling, Contracting Operations, Provider Enrollment and Value Based teams on initiatives that affect their region .
• Excellent working knowledge of and experience with Medicare reimbursement methodologies, case rate reimbursement methodologies, fee schedule development, utilizing financial models and analysis in negotiating rates with Payers.
• Working knowledge of value based care reimbursement models and the life cycle of value based care agreements
• Excellent organization abilities as well as written and oral communication skills
• Ability to manage team workforce and set his or her own priority list with little input from manager
• Creative and persistent problem solver while maintain attention to detail and accuracy
• Client / service oriented (internal and external)
• Maintain strict confidentiality of sensitive information
• Ability to interact and communicate clearly with individuals at all levels of organization
• Ability work in a group setting
• Ability to complete projects independently within established timeframes
• Intermediate skills in Microsoft Office suite products, and ability to navigate through any business related software

Experience

5 - 7+ years in Commercial Managed Care, Payer, Hospital, ASC settings with an emphasis on contract negotiations (Hospital, ASC and / or Physicians), including 1-3 years of experience managing contractors or contracting teams

List Special Job or Environmental Conditions

• Limited travel required
• 100% Remote

Pay Range : $120k-$130k annually. In addition, this role is eligible for a bonus opportunity. Exact pay will be determined based on candidate experience, geographical location, and size / complexity of the program(s) being supported.

This job description reflects the present requirements of the position. As duties and responsibilities change and develop, the job description will be reviewed and subject to amendment.