Planned Parenthood of Orange and San Bernardino Counties has an exciting full-time opportunity for a Director of Payer Services who is responsible for the strategic planning and management of PPOSBC contract negotiations, documentation and relationship management. Advises and provides guidance to other emerging markets on contracting standards and negotiations, which may include contract template review and input to senior management on recommended strategies, as well as involvement in specific negotiations and documentation. Collaborates with Financial Analysis and other areas to develop assessment and communication tools to monitor performance of the agreements and other information critical to the organization and oversee the review, negotiation, implementation and maintenance of HMO, ACO and fee for service contracts and related materials consistent with organization’s strategic goals, business and marketing plans.
Position responsibilities include:
- Consistently exhibits behavior and communication skills that demonstrate PPOSBC’s commitment to superior customer service, including quality, care and concern with each and every internal and external customer.
- Oversees the organization’s agreements by developing contracting strategies to ensure successful negotiation and execution of agreements favorable to PPOSBC.
- Develops and provides oversight to all payer contracting programs designed to improve operational performance of the agreements including facilitation of meetings between payers and internal departments.
- Ensures that the department complies with the requirements of the Centers for Medicare & Medicaid Services and other applicable laws and regulations.
- Oversees the analysis and ensures accuracy of the contractual agreements prior to execution.
- Maintains and submits contractual documents to comply with regulatory requirements.
- Monitors new Department of Corporation, CMS and other regulatory requirements and ensures contract meet the requirements.
- Oversees HMO / fee for service language reviews to ensure target language and rates are met.
- Identifies and creates processes to establish links between Contracting and other departments and develops and documents internal department’s contract requirements.
- Monitors provider network to identify contracting needs and opportunities and expands the HMO contracts.
- Oversees payer contract directory activities, including submission of new physicians and adds/changes to health plans.
- Advises the management team on emerging trends and methodologies in managed care contracting, payer relations and legal issues.
- Monitors industry trends, anticipates implications and opportunities and collaborates with the management team to develop and manage work plans for HMO / fee for service contracting activities.
- Represents the organization at external meetings.
- Uses, protects, and discloses HCP patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
- Maintain contracting calendars and/or a contract dashboard to ensure adherence to key contract dates/timelines related to contract requirements, adjustment and/or renewals.
- Maintain a selectively shared repository of all executed contracts, exhibits, handbooks, clinical and administrative guidelines, forms, etc. on behalf of the enterprise.
- Serve as a consultant, trainer and coach for all levels of staff throughout the enterprise related to managed care, insurance and ACA delivery system concepts, in addition, to serving as an internal expert for current and active contracts.
- Serve on committees and in roles that advance the voice of the external customer as the enterprise evaluates, creates and modifies work processes, employs new software, develops new products, etc.
- Disseminate, monitor and update information relevant to service delivery, contract deliverables and performance with clinical operations and administrative units.
- Actively participate in Enterprise companies education and training in managed care principles, current contracts and ACA key understandings so as to further assist in high performance, strategy development and opportunity/deployment activities.
- Establish relationships with community-based organizations, health care entities, and internal/external resources to support enrollment activities.
- Responsible for internal and external reporting requirements.
- Performs additional duties as assigned.
OTHER SKILLS and ABILITIES:
- Presentation, spreadsheet and word processing programs.
- Professionalism, diplomacy and tact.
- Ability to define problems, collect data, establish facts, and draw valid conclusions.
- Ability to negotiate with health plans, IPAs, Management to optimize organization’s visibility, relationships, quality of care, and strategic initiatives.
- Outstanding organizational and time management skills are essential.
- Must be able to handle varied tasks simultaneously and meet department deadlines/goals.
Some of the perks:
- Attractive benefits package including medical, dental, and vision coverage for you and eligible dependents, life insurance, and long term disability
- Generous vacation, sick, and holiday benefits
- Generous 401(k) matching contributions up to 8%