Region Contract Manager Payer Strategy

Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nations largest nonprofit Catholic healthcare organizations, CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2,300 clinics, care sites and 137 hospital-based locations, in addition to its home-based services and virtual care offerings. CommonSpirit has more than 157,000 employees, 45,000 nurses and 25,000 physicians and advanced practice providers across 24 states and contributes more than $4.2 billion annually in charity care, community benefits and unreimbursed government programs. Together with our patients, physicians, partners, and communities, we are creating a more just, equitable, and innovative healthcare delivery system.

Job Summary:

The Division Contract Manager for Payer Strategy & Relationships (PSR) is responsible for the management of the payer relationships. The Manager assists PSR leaders in the development, implementation and management of PSR system standards for contracting and payer relations on a divisional level. Accountabilities include: implementing departmental policies and procedures that focused on maintaining positive working relationships with Payers; coordinating directly with internal & external stakeholders to ensure contract compliance on a regional and market level; ensuring that managed care contracts are correctly negotiated and implemented for operational compliance across the division.

The Contract Manager for Payer Strategy and Relationships (PSR) assists PSR leaders in the development, implementation and management of PSR system standards for contracting and payer relations. Accountabilities include: ensuring that managed care contracts are correctly negotiated and implemented for operational compliance across the division; implementing departmental policies and procedures that focus on maintaining positive working relationships with Payers and Providers; Coordinating directly with internal and external stakeholders to ensure contract compliance on a regional and market level.

Essential Key Job Responsibilities:

• Negotiates contracts with Payers on behalf of Providers (including hospitals, physicians, ambulatory surgery centers and other affiliated providers as assigned) and with Providers on behalf of capitated hospitals.
• Contracts may include letters of agreement and single case agreements at the direction of senior leadership.
• Maintains supportive relationships with key departments that support the division in order to quickly resolve contract-related issues.
• Ensures complex payer information and reports are analyzed and summarized to provide timely operationaland contracting recommendations for key internal leaders. Research contract and regulations to assist with claim payment issues and/or credentialing issues with payers.
• Drafts and summarizes content for official correspondence as issues arise with policy updates or compliance with agreements.
• Assists with updating project plan documents and communications plans.
• Monitors contract terms, termination dates, and rate update deadlines to assure proper and timely notification is achieved in compliance with project plan and strategy.
• Assists in developing tools/updates for communicating and operationalizing contract terms, amendments, and policy terms.
• Adheres to all established contracting guidelines. Contracting accountability for negotiation support include hospital, physician, and ancillary services.

Minimum Qualifications:

• Bachelors Degree or equivalent experience in managed care contracting may be considered in lieu of degree.
• Minimum of three (3) years of experience in healthcare contracting

Required Knowledge, Skills and Abilities

• Knowledge and experience in reimbursement, the financial aspects of contracting and managed care operations
• Contract language
• Effective project planning skills
• Excellent written and verbal communication skills
• Working knowledge of state and federal programs such as Medicaid and Medicare
• Working knowledge of various reimbursement methodologies including DRGs, per diems, RVUs
• Ability to effectively work within a highly matrix-oriented organization