Senior Director, Payer Contracting
Job Description
At Scripps Health, you will experience the pride, support, respect that has been repeatedly recognized as one of the nation's Top 100 Places to Work.
You'll be surrounded by people committed to making a difference in the lives of their patients and their teammates. So, if you're open to change, go ahead, and unlock your potential.
Primary job responsibilities will include:
* Negotiates fee-for-service, partial risk and full global risk HMO, PPO and Ancillary services managed care agreements with health plans on behalf of Scripps Health's hospitals/facilities or Scripps Medical Foundation and partner medical groups or a combination of both in order to achieve Scripps Health's targeted revenue increases and overall goals.
* Oversees the analysis, management, accounting and budgeting of all managed care agreements.
* Establishes effective lines of communications between Payer Relations and Patient Financial Services, Business Services and Scripps Health Plan Services in order to maximize contract effectiveness and ease of administration.
* Negotiates settlements and resolves disputes between Scripps Health, Scripps Health Plan Services and health plans.
* Presents the results to all levels of management at Scripps Health and Scripps Health Plan Services in order to support its negotiating position.
* Communicates with health plans upon acquisition of hospitals, ancillary facilities and medical groups in order to include them in HMO, PPO and Ancillary services managed care agreements.
* Participates in strategy development for Scripps Health/Scripps Health Plan Services payer contracting.
* Manages a staff consisting of analytic, contracting and provider relations professionals.
Senior Director position eligible to participate in the Director Incentive Plan.
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Required Education/Experience/Specialized Skills:
* Bachelor's degree plus ten (10) years of management experience in hospital and medical group fee-for-service, partial risk and full global risk HMO, PPO and ancillary services negotiations and contracting experience, including strong knowledge of legal and financial issues.
Preferred Education/Experience/Specialized Skills/Certification:
* Master's degree in business or health care administration or related field
* Fifteen (15) years of hospital and medical group fee-for-service, partial risk and full global risk HMO, PPO and ancillary services negotiations and contracting experience.
* Strong financial modeling and analytic skills and experience overseeing this function in a multi-institutional/medical group setting.
Scripps Health is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, age, status as a protected veteran, among other things, or status as a qualified individual with disability.
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