Market Director Payer Strategy TX

CommonSpirit Health is one of the nation’s largest nonprofit Catholic healthcare organizations, dedicated to building a healthier future through integrated health services. The Market Director, Payer Strategy and Relationships is responsible for managed care policies, negotiation strategies, and maintaining payer relationships to ensure optimal reimbursement and support the organization's financial performance.

Responsibilities:

• Responsible for managed care policies, goals and objectives related to contract language and reimbursement, negotiation strategy, and payer relationships
• Collects and communicates Market-level insight and strategic knowledge to/from the PSR National Payer teams, the PSR Growth and Innovation team, and other key departments across the enterprise
• Secures optimal fee for service and value-based reimbursement, protects the interests of the owned and/or affiliated hospitals/ancillaries/professional provider entities in contract negotiations, and strengthens CommonSpirit Health’s relationships with payers
• Participates in the development of Market strategy, relationships, and contracts with local and national payers to further drive a clear and effective negotiation strategy, reimbursement structure, contract renewal planning process, and contract implementation
• Gathers information and guidance from Region PSR VP, ministry leaders, internal stakeholders, and financial analysis relative to the strategic, operational, financial needs and expectations of the Market related to the National Payers; proactively communicates with the PSR National Payer teams
• Establishes, builds, and maintains positive, strategic interactions and relationships with payers, employers, providers, and leaders across the ministry
• Maintains relationships with National Payer contacts with offices in the Market
• In collaboration with Region Leadership and other PS&R Leadership, develops and executes communication plans and Payer Negotiation Outlines related to payer relationships, negotiations, organizational contractual obligations, and developments in the managed care marketplace including Fee For Service and Value-Based Agreements in support of CommonSpirit Health’s Healthier Communities strategy
• Makes independent decisions and/or exercises judgment based upon appropriate information and objectives
• Comprehends and maintains highly detailed information
• Accepts and carries out responsibility for direction, control, and planning
• Stays current with emerging payer trends, new reimbursement methodologies, state specific regulatory issues, plan benefits, payer activity, products and delivery channels including health insurance exchanges, market competition, etc
• Supports the strategic objectives of CommonSpirit Health’s IDNs, population health, and care management initiatives through directly engaging local payers and employer customers, including CSH employee health benefits
• Participates in and contributes to CommonSpirit Health’s PSR knowledge base through sharing best practices, developing contract performance goals, key metrics, new analytical tools, network development, reimbursement and language guidelines, revenue realization, and other applicable work streams
• Participates in the dispute resolution and denials processes with local payers if the materiality exceeds $1M
• Participates in joint operating committees and denial committees for Market
• Leads and organizes sub-projects necessary to support local and national payer negotiations and growth

Requirements:

• Bachelor's Degree – equivalent education and experience in payer strategy, managed care or provider network senior level role may be considered in lieu of degree
• Minimum of five (5) years of experience in healthcare or managed care industry
• Minimum of four (4) years of leadership experience