Division Manager Contracts PSR

Company: Dignity Health
Location: Phoenix
Posted on: May 28, 2023

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