Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advanced technology. Capital Health is a dynamic health care resource accredited by the DNV that includes two hospitals, an outpatient center, satellite ED, and an expansive network of primary and specialty care. Capital Health Medical Group is made up of more than 600 physicians and other providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region.
Capital Health recognizes that attracting the best talent is key to our strategy and success as an organization. As a result, we aim for flexibility in structuring competitive compensation offers to ensure we can attract the best candidates.
The listed pay range or pay rate reflects compensation for a full-time equivalent (1.0 FTE) position. Actual compensation may differ depending on assigned hours and position status (e.g., part-time).
Pay Range:
$88,712.00 - $115,918.40Scheduled Weekly Hours:
40Position Overview
Support Payor operations to enhance relationships and improve operational, efficiency with Commercial, Medicare, Medicaid and other insurance programs. Responsible for enhancing reimbursement, network access and reducing revenue cycle challenges.
MINIMUM REQUIREMENTS
Education: Bachelor’s degree in Accounting, Business or related field. A high school diploma or equivalent and additional years of experience may be considered in lieu of a formal Bachelor's degree.
Experience: Four years of progressively responsible experience in payor contracting and payor relation activities when accompanied by a Bachelor's degree. Eight years of progressively responsible experience in payor contracting and payor relation activities when accompanied by a high school diploma or equivalent. Prior management experience is preferred.
Other Credentials:
Knowledge and Skills: Knowledge of contract management systems; strong analytical and interpretive skills. Possesses excellent organizational, interpersonal, verbal, and written communication skills, leadership and problem-solving skills. Ability to effectively manage multiple projects simultaneously and ability to respond quickly in a fast-paced environment.
Special Training: Familiarity with medical terminology, CPT and ICD-10.
Mental, Behavioral and Emotional Abilities:
Usual Work Day: 8 Hours
Reporting Relationships
Does this position formally supervise employees? Yes
If set to YES, then this position has the authority (delegated) to hire, terminate, discipline, promote or effectively recommend such to manager.
ESSENTIAL FUNCTIONS
Maintains and enhances relationships with payors to improve efficiency of revenue cycle, contracting and working relations.
In collaboration with VP of Payor Relations, assist in preparation to develop positive relationships and effective communication channels with payors to improve operational relationships and resolve issues
Attends payor meetings to review operational issues. Maintain and communicate with payor outstanding issues and needs.
Participates and supports payor contracting negotiation strategies and implementation.
Collaborates with senior leadership to align payer strategies with overall organizational goals.
Provides support and guidance to leadership to monitor and report financial performance of assigned payor contracts versus expectations to assure achievement of negotiated rates
Develops and monitors KPIs to monitor payor performance. Assess payor contracts to identify challenges and opportunities to improve hospital reimbursement and operational efficiency.
Utilizes data and other KPIs to recommend strategies to optimize payor mix and reimbursement rates.
Monitors and manages payor contracts to assure payor adherence to contracted terms. Identify operational challenges with contracts and provides recommendations during contract negotiations.
Monitors and measures payor issues that impact Revenue cycle, Quality and Utilization Review.
Escalate, address and resolve issues and disputes with payers in a timely and effective manner.
Monitors changes in market trends, healthcare laws, regulations and clinical policies that impact payor contracts and relationships. Provide recommendations to address such issues.
Communicates and facilitates sessions on key contract and policy changes and communicates findings with leadership of the organization. Takes necessary action based on Leadership feedback.
Manages and oversees the contract amendments, policy changes, etc. on a timely basis so that CH has an opportunity to appeal the change according to the contract terms.
Notify payors of charge increase in accordance with contract terms.
Monitors existing agreements to assure new services/facilities are contracted for in-network participation. Notify payors of any new service line.
Performs other related duties as required or assigned.
PHYSICAL DEMANDS AND WORK ENVIRONMENT
Frequent physical demands include:
Occasional physical demands include: Standing , Walking , Climbing (e.g., stairs or ladders) , Carry objects , Push/Pull , Twisting , Bending , Reaching forward , Reaching overhead , Squat/kneel/crawl
Continuous physical demands include: Keyboard use/repetitive motion , Talk or Hear
Lifting Floor to Waist 20 lbs. Lifting Waist Level and Above 10 lbs.
Sensory Requirements include: Accurate Near Vision, Accurate Far Vision, Accurate Color Discrimination, Accurate Depth Perception, Accurate Hearing
Anticipated Occupational Exposure Risks Include the following: N/A
This position is eligible for the following benefits:
Medical Plan
Prescription drug coverage & In-House Employee Pharmacy
Dental Plan
Vision Plan
Flexible Spending Account (FSA)
- Healthcare FSA
- Dependent Care FSA
Retirement Savings and Investment Plan
Basic Group Term Life and Accidental Death & Dismemberment (AD&D) Insurance
Supplemental Group Term Life & Accidental Death & Dismemberment Insurance
Disability Benefits – Long Term Disability (LTD)
Disability Benefits – Short Term Disability (STD)
Employee Assistance Program
Commuter Transit
Commuter Parking
Supplemental Life Insurance
- Voluntary Life Spouse
- Voluntary Life Employee
- Voluntary Life Child
Voluntary Legal Services
Voluntary Accident, Critical Illness and Hospital Indemnity Insurance
Voluntary Identity Theft Insurance
Voluntary Pet Insurance
Paid Time-Off Program
The pay range listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining base salary and/or rate, several factors may be considered including, but not limited to location, years of relevant experience, education, credentials, negotiated contracts, budget, market data, and internal equity. Bonus and/or incentive eligibility are determined by role and level.
The salary applies specifically to the position being advertised and does not include potential bonuses, incentive compensation, differential pay or other forms of compensation, compensation allowance, or benefits health or welfare. Actual total compensation may vary based on factors such as experience, skills, qualifications, and other relevant criteria.