Payer Contracting Senior Manager

Job Description:
This position is responsible for the effective management of assigned contractual associations with payers. The Senior Manager is responsible for high-level, strategic accounts that bring significant revenue to Intermountain and represent strategically significant associations.
This position can be performed remotely with minimal travel. Intermountain Health maintains employment registration in Utah, Idaho, Nevada, Colorado, Montana, Wyoming, and Kansas. Other locations may be considered. Currently, we are not hiri ng remote workers in the following states: CA, HI, IL, PA, RI, WA.
The Senior Manager is the liaison between Intermountain Health and the payer and works to establish genuine, sincere and long-term, community-oriented business relationships with assigned payers. The Senior Manager is the strategic lead on assigned payer accounts and must continually assess and evaluate the association and suggest opportunities to refine and improve the relationship. The Senior Manager must ensure that contract language is consistent with contracting standards and does not pose significant financial, legal, administrative or political risk for Intermountain. The Senior Manager is also responsible for the complete and effective management and/or resolution of department and organization projects as assigned by the director or senior manager. The Senior Manager must be conversant with industry developments and proactively propose evolving contract strategies to ensure contracts remain relevant and beneficial to Intermountain. The Senior Manager is the liaison between payers and assigned Intermountain regions.
- Establishes and Maintains Effective Long-term Payer Associations: Works effectively with payers to establish long-term and sincere business associations. Acts as a payer advocate in issues resolution, while still maintaining consistency with established policies and keeping Intermountain's best interests in focus. Reaches out to payers in an effective and strategic manner to ensure the association is mutually beneficial. Ensures that Intermountain's commitment to the community is advanced through the establishment and retention of mutually beneficial contracts with various payers.
- Manages Contractual Associations: Ensures that all contracts are properly drafted and executed, and that terms and conditions are fair and consistent with other payers. Tracks financial performance of all assigned accounts. Accountable for contract compliance. Responsible for claims resolution and assertive resolution of financial or other contract non-compliance. Networks within the Intermountain system to effectively manage payer associations. Coordinates with internal parties to implement and maintain payer associations. Fills the lead role in contract negotiations and re-negotiations on assigned accounts and effectively and skillfully represents Intermountain to finalize favorable contracts for the organization. Supervises resolution of all contract related issues (claims, administration, etc.).
- System Coordination and Networking: Coordinates with all impacted areas of the Intermountain system to advise affected divisions regarding the impacts of payer contracts. Accountable for assigned region coordination. Responsible to coordinate new contracts, new opportunities, new risks and challenges with an assigned Intermountain region(s).
- Contract / System Expertise: Possesses a strong and increasing working knowledge of the contracting process between Intermountain and payers and acts as a subject matter expert and resource to others. Knows and communicates Intermountain policies and procedures to payers. Confident and skilled in responding to payer inquiries and provides answers and information as appropriate to ensure clarity and efficiency.
- Strategic Vision: Conversant with the ever-changing healthcare market and applies the most current language, processes and regulations to contracts and messaging. Identifies risks and opportunities for Intermountain and makes strategic proposals to further Intermountain's strategic standing in the market. Contributes to the preparation and development of materials and discussion items for the Payer Contracting Monthly Update for ELT Members. Analyzes financial data to reach accurate conclusions and acts upon metrics that are inconsistent with established standards.
- Contract / Document Development: Creates effective contract language and other documents by concisely and effectively communicating in written and verbal mediums to various large and small committees and groups, internally and externally. Synthesizes complex topics and summarizes them into concise presentations without compromising material details.
- Industry Expertise: Demonstrates a solid and strong working knowledge of hospital and physician payment methodologies for commercial and government payers and ensures that department processes are aligned with such programs.
- Project Ownership: As new strategies and organization initiatives are developed, the Senior Manager takes the lead, as assigned, to champion new strategies / initiatives with payers and with system stakeholders.
- Government Programs: Possesses a working knowledge of government healthcare plans (TriCare, Medicare, Medicaid, Medicare Advantage, CHIP, HIP, etc.) and applies current requirements to those contracts. Champions and advocates for effective contracts.
- Commercial Insurers: Demonstrates a skilled understanding of commercial insurance, particularly for the specific benefit plan designs, payment structures and insurance offerings represented by assigned payers and incorporates that knowledge into those contracts in order to ensure effectiveness.
- Professional Enthusiasm: Demonstrates professional and personal confidence and enthusiastically represents Intermountain in discussions with payers in a manner that establishes credibility and validity.
Minimum Qualification:
- Bachelor's Degree. Degree must be obtained through an accredited institution. Education is verified.
- Five years of professional experience in a role requiring extensive writing, analysis, contract management, customer service project management, negotiation, and verbal presentations.
- Five years of experience in a role requiring management of projects and accountabilities from inception to conclusion in an effective and comprehensive manner that appropriately evaluates implications and results in solid solutions, securing beneficial results that add value and contribute to strategic direction.
- Five years of experience in analytics, contract writing, negotiating, and managing projects.
- Experience using word processing, spreadsheet, database, internet and e-mail, and scheduling applications.
- Experience in a professional role requiring effective verbal communication to present advanced topics in a clear, concise, polished, and professional manner.
- Demonstrated ability to synthesize extensive amounts of data into clear and concise summaries without sacrificing material details.
- Demonstrated ability and willingness to travel to conduct negotiations, investigate opportunities, and further associations with contracted payers.
Preferred Qualifications :
- Experience writing data queries
- Five years experience in the health care industry or health insurance industry.
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With this position, you are eligible to participate in the Annual Pay for Performance (AP4P) Plan. This plan enables Intermountain Health to provide leaders with an additional performance compensation opportunity. The AP4P award opportunities are calculated as a percentage of your base salary. Awards are paid out based on attainment of selected Board-approved goals.
Physical Requirements:
Interact with others requiring the employee to communicate information.
- and -
Operate computers and other office equipment requiring the ability to move fingers and hands.
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See and read computer monitors and documents.
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Remain sitting or standing for long periods of time to perform work on a computer, telephone, or other equipment.
Anticipated job posting close date:
05/12/2024
Location:
Key Bank Tower
Work City:
Salt Lake City
Work State:
Utah
Scheduled Weekly Hours:
40
The hourly range for this position is listed below. Actual hourly rate dependent upon experience.
$57.18 - $88.26
We care about your well-being - mind, body, and spirit - which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.
Learn more about our comprehensive benefits packages for our Idaho, Nevada, and Utah based caregivers (https://intermountainhealthcare.org/careers/working-for-intermountain/employee-benefits/) , and for our Colorado, Montana, and Kansas based caregivers (http://www.sclhealthbenefits.org) ; and our commitment to diversity, equity, and inclusion (https://intermountainhealthcare.org/careers/working-for-intermountain/diversity/) .
Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.
Intermountain Health is a Utah-based, not-for-profit system of 33 hospitals (includes "virtual" hospital), a Medical Group with more than 3,800 physicians and advanced practice clinicians at about 385 clinics, a health plans division called Select Health, and other health services. Helping people live the healthiest lives possible, Intermountain is widely recognized as a leader in clinical quality improvement and efficient healthcare delivery.
Join our world-class team and embark on a career filled with opportunities, strength, innovation, and fulfillment.
To find out more about us, head to our career site here (https://intermountainhealthcare.org/careers/?utm\source=Workday&utm\medium=Redirect&utm\campaign=CareerHome\workday) .
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Intermountain Health strives to make the application process accessible to all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact 1-800-843-7820 or email recruitment@imail.org . This contact information is for accommodation requests only and cannot be used to inquire about the status of applications.
We intentionally work toward an Intermountain Health that reflects our diverse communities and provides culturally competent care, health equity, and a sense of belonging amongst all our caregivers (employees). This is an important part of fulfilling our mission to help people live the healthiest lives possible. The three pillars of our work are talent experience with Intermountain (application, internship, development, etc.), community benefit, and care delivery.
Learn more about diversity at Intermountain, here. (https://intermountainhealthcare.org/careers/working-for-intermountain/diversity/)
Introduce yourself to our Talent Acquisition team and we will get in touch if there is a role that seems like a good match.
Intermountain Health's PEAK program supports caregivers in the pursuit of their education goals and career aspirations by providing up-front tuition coverage paid directly to the academic institution. The program offers 100+ learning options to choose from, including undergraduate studies, high school diplomas, and professional skills and certificates. Caregivers are eligible to participate in PEAK on day 1 of employment. Learn more. (https://intermountainhealthcare.org/careers/working-for-intermountain/employee-benefits/peak-program/)
The primary intent of this job description is to set a fair and equitable rate of pay for this classification. Only those key duties necessary for proper job evaluation and/or labor market analysis have been included. Other duties may be assigned by the supervisor.
All positions subject to close without notice.
Thanks for your interest in continuing your career with our team!