Director-Payor Relations-Payor Relations

Job Objective:

Responsible for all payor relationships for Eisenhower Health and its affiliates including but not limited to contracting functions with all Payors.

Essential Responsibilities:

• Demonstrates compliance with Code of Conduct and Compliance Policies and takes action to resolve compliance questions or concerns and reports suspected violations.
• Develops payor contracting strategy, goals and objectives. Maintains policies and procedures for payor relations and contracting.
• Practices hospital-wide scripts and ensures scripting is being utilized in areas of responsibility.
• Conducts market analyses including market trends and competitor analysis and profit/loss analyses to support Payor negotiating and contracting.
• Develops strategies, establish priorities and goals, and conduct contract negotiations to meet EMC and its affiliates reimbursement goals within approved authority limits.
• Establishes and enhances relationships with payors, physicians, employers and brokers to increase EMC market presence.
• Establishes interdepartmental procedures whereby all department managers who have a functional interest in or whose responsibilities are impacted by Payor contracts are kept informed and involved in the Payor contracting.
• Establishes standard contracting procedures and clauses to assure completeness of each contract and consistency between contracts.
• Establishes and maintains a contract tracking system to assure that contracts are reviewed and renewed on a timely basis.
• Develops and produces periodic individual financial reports and comparative performance reports for all Payor contracts.
• Participates in overseeing the maintenance and accuracy of the contract reimbursement program.
• Monitors and follows up after contract signing to assure that EMC is meeting our obligations under the payor contracts and that the payers are complying with payment rates and terms and conditions of the contracts. Timely and accurate payment is made for services.
• Establishes interdepartmental procedures and relationships that will allow a quick response and resolution to contract or Payor problems encountered at any level of hospital.
• Coordinates and integrates payor relations including contracting with hospital departments.
• Assesses, plans and implements process improvement strategies, maintains appropriate quality control.

Essential Skils:

• Possesses a professional appearance and excellent oral, analytical and written skills
• Financial and micro-economic analysis (eg cost-benefit, profit/loss, etc) and contract negotiation
• Ability to make decisions
• Superior interpersonal skills
• Has stategic focus and is seen as collaborative in nature
• Ability to make presentations to Executive Groups
• Highly organized
• Ablility to act as mentor and educate staff at all levels of the organization