Senior Director – Payer Contracting

Role Overview

• Leads contract negotiations, as assigned, including risk-based agreements, fee-for-service negotiations, pay for performance programs, and ACO agreements with health plans
• Manages contractual relationships with payers and internal stakeholders
• Reviews health plan contract language and is familiar with payor, medical group/IPA, and hospital/ancillary contract language and reimbursement mechanisms
• Circulates draft contract terms/language to various internal departments for review & approval
• Applies knowledge of healthcare delivery system, IPA operations, managed care, healthcare laws in assisting with the development of contracting strategies
• Answers and/or resolves inquiries from health plans or internal departments in a timely manner
• Establishes good working relationships with health plan representatives and internal teams
• Develops tools (e.g., dashboards, grids, tables, summaries) to provide organizational leadership key contract data
• Utilizes applicable financial tools and reports to evaluate performance of current contracts
• Interacts and consults with Network Pricing team to evaluate different financial arrangements and recommend applicable payment methodologies
• Ensures compliance and consistent contracting across the enterprise.
• Manages various ad-hoc project requests with short turnaround time.
• Performs other duties as assigned.

Requirements

• Master’s degree and/or Bachelor’s degree or BS/BA in business administration or health care related field of study or equivalent years of experience
• Direct experience leading health plan/provider negotiations
• Experience with financial models analyzing health plan agreements
• At least 10 years prior experience in contracting
• Experience in risk-based contracting and associated financial analysis strongly preferred
• Ability to close deals under tight deadlines-sense of urgency
• Comfortable in negotiating all types contracts from start to finish within defined parameters
• Experience with FFS, capitation, and risk sharing arrangements
• Experience with government programs (Medicare, Medi-Cal, D-SNP)
• Experience working with health plan, provider and hospital counterparts
• Knowledge of California payer, Institutional and IPA contracting
• Successful experience negotiating contracts for all Lines of Business (Commercial, Medicare, Medicaid, and Accountable Care)
• Project management skills/experience
• Advanced MS Word capabilities: find & replace, redlining, comment insertion, track changes and document compare
• Proficient in MS Excel (including use of functions and pivot tables) and PowerPoint software
• Demonstrated ability to work with effectively with multiple different areas within an organization (both internal and external)
• Proven ability to work effectively both independently and with teams in a dynamic and fast paced environment
• Proven leadership/strategy and organizational skills are required, as well as excellent written and verbal communication skills
• Strong interpersonal and communication skills and ability to work effectively with a wide range of constituencies
• Experience with healthcare operations, systems, and financial/claims data analysis

Benefits

• Our organization follows a hybrid work structure where the expectation is to work both in office and at home on a weekly basis. The office is located at 1600 Corporate Center Dr. Monterey Park, CA 91754 and 600 City Parkway West, Orange, CA 92868.
• Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com** **to request an accommodation.