Division Manager Contracts PSR
Company: Dignity Health
Location: Phoenix
Posted on: May 28, 2023
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Job Description:
Overview:CommonSpirit Health was formed by the alignment of
Catholic Health Initiatives (CHI) and Dignity Health. With more
than 700 care sites across the U.S. from clinics and hospitals to
home-based care and virtual care services CommonSpirit is
accessible to nearly one out of every four U.S. residents. Our
world needs compassion like never before. Our communities need
caring and our families need protection. With our combined
resources CommonSpirit is committed to building healthy communities
advocating for those who are poor and vulnerable and innovating how
and where healing can happen both inside our hospitals and out in
the community.Responsibilities:Job SummaryThe Division Contract
Manager for Payer Strategy & Relationships (PSR) assists PSR
leaders in the development, implementation and management of PSR
system standards for contracting and payer relations.
Accountabilities include: ensuring that managed care contracts are
correctly negotiated and implemented for operational compliance
across the division; implementing departmental policies and
procedures that focus on maintaining positive working relationships
with Payers and Providers; coordinating directly with internal &
external stakeholders to ensure contract compliance on a regional
and market level. Essential Key Job Responsibilities Negotiates
contracts with Payers on behalf of Providers (including hospitals,
physicians, ambulatory surgery centers and other affiliated
providers as assigned) and with Providers on behalf of capitated
hospitals. Contracts may include letters of agreement and single
case agreements at the direction of senior leadership. Maintains
supportive relationships with key departments that support the
division in order to quickly resolve contract-related
issues.Ensures complex payer information and reports are analyzed
and summarized to provide timely operational and contracting
recommendations for key internal leaders. Research contract and
regulations to assist with claim payment issues and/or
credentialing issues with payers.Drafts and summarizes content for
official correspondence as issues arise with policy updates or
compliance with agreements.Assists with updating project plan
documents and communications plans.Monitors contract terms,
termination dates, and rate update deadlines to assure proper and
timely notification is achieved in compliance with project plan and
strategy. Assists in developing tools/updates for communicating and
operationalizing contract terms, amendments, and policy terms.
Adheres to all established contracting guidelines. Contracting
accountability for negotiation support include hospital, physician,
and ancillary services.As applicable, ensure standardized monthly,
quarterly and ad-hoc meetings with Managed Care Organizations occur
and issues are resolved in a timely fashion. Participate in joint
operating committee meetings with payers, medical groups or
providers as neededQualifications:Bachelors Degree equivalent
experience and/or education in Finance and health care may be
considered in lieu of degreeMinimum of three (3) years of
experience in Finance and/or health care contractingIf applicable,
additional certification(s), demonstrating industry knowledge in
regulatory updates and their application to managed care payers,
such as provided by AAMAS or AAMN preferred.Knowledge and
experience in reimbursement, the financial aspects of contracting
and managed care operations Effective project planning
skillsExcellent written and verbal communication skills Working
knowledge of state and federal programs such as Medicaid and
MedicareWorking knowledge of various reimbursement methodologies
including DRGs, per diems, RVUsAbility to effectively work within a
highly matrix-oriented organization
Keywords: Dignity Health, Phoenix , Division Manager Contracts PSR, Executive , Phoenix, Arizona
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