Regional Director, Payor Contracting

Eyecare Partners

  • Ballwin, MO
  • Permanent
  • Full-time
  • 1 month ago
EyeCare Partners is the nation's leading provider of clinically integrated eye care. Our national network of over 300 ophthalmologists and 700 optometrists provides a lifetime of care to our patients with a mission to enhance vision, advance eye care and improve lives. Based in St. Louis, Missouri, over 650 ECP-affiliated practice locations provide care in 18 states and 80 markets, providing services that span the eye care continuum. For more information, visit .SUMMARYUnder the strategic direction of the VP, Payor Contracting, the Regional Director, Payor Contracting is responsible for all duties related to managing payer relationships, negotiations, financial modeling, and tracking of new and existing payer contracts for a specific region. The Regional Director, Payor Contracting and Network Development is responsible for all duties related to managing payer relationships, negotiations, financial modeling, and tracking of new and existing payer contracts for a specific geographic region of the country with the primary goals of a) maximizing commercial contract net revenue and b) proactively identifying opportunities for the department to increase revenue, save workload, and missed opportunities, c) recognizing new business opportunities for long term development.In addition, this position will involve developing and implementing strategic relationships with major Payors on a regional and/or national level while working in a matrixed manner with members of the Revenue Cycle, Business Operations, Implementation, Financial Modeling, and Provider Enrollment regarding contracting, business development opportunities, financial and strategic objectives affecting that effect specific geographical region.ESSENTIAL DUTIES AND RESPONSIBILITIES
  • Regional oversight of the strategic 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 presenting them clearly when a decision needs to be made.
  • Development and management of the region's Managed Care Work Plan, annual contracting budget, and strategy for the assigned region(s).
  • Generate necessary reports for the VP and executive team. In addition, responsible for monitoring all reports, data, and information related to managed care contracting for the assigned region(s).
  • Assess and report progress in meeting department objectives (Budget, Strategic, etc.). Proactively manage situations impacting the ability to deliver in accordance with the work plan and the Managed Care Strategy. Ensure that leaders are informed regarding situations or issues that need to be escalated.
  • Understands not only contracting end to end but also understands the whole Revenue Cycle continuum as well as good working knowledge of the payor's footprint and strategies in the assigned market and have a high-level understanding of EyeCare Partners' Clinic and ASC's operations.
  • Readily embrace change and be a positive role model and change leader as needed.
  • Mentor Sr. Payor Contracting Managers, Payor Contracting Managers, and Payor Contracting Specialist, as needed, in all aspects of payer contracting activities.
  • Serve as a company steward, be present, visit the various clinics as needed and represent the Managed Care Department in a positive and strategic manner with Regional Operations, RCM and others.
  • Performs other related duties and special projects as assigned.
QUALIFICATIONS
  • Proven sound judgment and decision-making skills in a timely and effective manner. Ability to gather and use pertinent data and facts to identify and solve a range of problems related to managed care strategy, contracting, and escalated issues.
  • Extensive knowledge of managed care, reimbursement, policies, and strategies
  • Tenacious personality with the ability to complete projects in a timely and effective manner
  • Additional experience in RCM and/or finance is a plus.
  • Ability to identify opportunities and threats and develop and implement an action plan which may include multiple internal and external departments and participants.
  • Proven track record of successful contract negotiations in different markets, and multiple states.
  • Strategic thinker, able to quickly assess the situation and provide resolution.
  • Ability to accept responsibility and hold self and others accountable.
  • Able to work in a fast-paced environment and willing to accept new challenges and meet deadlines.
  • Strong written and spoken communication skills.
EDUCATION AND/OR EXPERIENCE
  • 8 + years of experience in a position that is directly responsible for contract negotiations for a payor, provider, or both.
  • Bachelor's Degree focused on health care administration, business, or finance. Will accept 10 years of progressive direct contracting experience in addition to 2 years of experience working in RCM in leu of a degree.
  • Master's degree: MSPH, MHA or MBA preferred.
  • Proven track record of managing contract negotiations in multiple markets and states.
LICENSES AND CREDENTIALSSYSTEMS AND TECHNOLOGYExceptional skills in Microsoft Excel, Word, PowerPoint, OutlookIf you need assistance with this application, please contact (636) 227-2600. Please do not contact the office directly - only resumes submitted through this website will be considered.EyeCare Partners is an equal opportunity/affirmative action employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.

Eyecare Partners