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Nicklaus Children's Health System

Director Payer Contract/Ops/Credentialing

Place: Miami, Miami, United States
Posted: Yesterday

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Applies on careers.nicklaushealth.org

The role

Description

Job Summary

Responsible for technical and professional payer contracting and credentialing for the entire Health System. Provides guidance and support to Senior Leadership in aspects of payer contracting/negotiations, pricing, and delegated credentialing for the Health System. Responsible for pivoting and adapting NCHS to an everchanging payer landscape and reimbursement structure. Be a role model and leader to direct reports and develop a strong educated and impactful team bench.

Job Specific Duties

Responsible for detailed understanding of health care industry, market dynamics, trends, competitors, regulations, and payer environment.

Collaborates with the management team and all departmental levels on both the hospital and physician sides. Ensure operational issues are addressed and remedied through negotiation, project planning, or contract modification.

Creates and maintains professional relationships with payers and potential affiliates.

Creates, analyzes, and interprets financial reports to support payer negotiations, trends, and audit.

Implements and communicates contracting strategies in collaboration with Senior Leader.

Manages all out of network contracting for both hospital and employed physicians.

Responsible for the management and development of subordinates.

Knowledge and willingness to support new contracting strategies and approaches. Innovative and out of box thinker

Provides direction, feedback, and recommendations on trended payer performance; serves as the SME for all payer related contractual arrangements/issues- current and historical.

Responsible for overseeing the management of all in network and out of network contracting and negotiations for the hospital and employed physician group.

Responsible for making high impact decisions steeped in judgment.

Develop and lead Joint Operating Committee meeting with payers and respective NCHS departments.

Complies with legal and regulatory compliance requirements.

Leads and oversees Corporate Credentialing function.

Qualifications

Minimum Job Requirements

Bachelor's Degree in Business Administration or Health Management

7-10 years of management experience in the finance/analytics/accounting field- healthcare related.

7-10 years of hospital or payer contracting and negotiating experience.

Knowledge, Skills, and Abilities

MBA, MHA, and or JD preferred.

Work well under immense pressure with an ability to focus on multiple priorities while maintaining focus, attention to detail, and connecting all the dots.

Demonstrated leadership progression.

Knowledge of Governmental and Commercial payer fee for volume and fee for value reimbursement methods.

Strong analytical and contract language interpretation skills.

Familiarity working with Lawyers and interpreting statutes and regulations.

Business acumen and strong financial skills.

Excellent written, oral, and communications skills.

Success in persuasion, influence, and negotiation skills.

Management expertise, strong knowledge of data analysis, and statistics.

Able to handle day to day administrative routine, as well as, constantly changing, competing projects, urgent situations, sometimes simultaneously.

Able to relate cooperatively and constructively with payers and co-workers.

Effective communicator with a strong, transparent, and clear style; ability to deliver tough messages with tact.

Effectively monitor and develop the abilities of subordinates.

Able to maintain confidentiality of sensitive information.

Knowledge of payer and hospital credentialing function.

Ability to interpret, adapt, and react calmly under stressful conditions.

Ability to analyze and interpret complex models and apply to business ask; strong spreadsheet skills.

Ability to use logical & scientific thinking to interpret technical data and solve a broad range of problems.

Able to relate cooperatively and constructively with medical staff, executives, staff, elected officials, and managed care companies.

Independent and self starter with exceptional judgement and time management skills

Job:

Management

Department:

NCHS-MANAGED CARE CONTRACTING-1000-900910

Job Status:

Professional