Chief - Payer Relations & Managed Care

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Important Applications Instructions:
Please complete this application in entirety by providing all of your work experience, education and certifications/
license. You will be unable to edit/add/change your application once it is submitted.
Job Requisition ID:
R00034961
Job Category:
Professional and Technical
Organization:
Chief Financial Officer
Location/s:
Main Campus Jackson
Job Title:
Chief - Payer Relations & Managed Care
Job Summary:
The Chief of Payer Relations and Managed Care will provide overall leadership of UMMC's Managed Care contracting function to include three hospitals and a multi-specialty faculty practice plan of over 600 providers. This position will function effectively as the health system liaison with insurance company leadership teams. This role will negotiate and oversee all aspects of Managed Care contracts, including reimbursement analysis through strong financial analytic support and negotiate contract terms in accordance with established goals. Advises Vice Chancellor, Chief Financial Officer and other senior executives on key payer and reimbursement issues. This position will also work in partnership with the chief of hospital case management and the chief revenue cycle officer to maximize patient access and maximize reimbursement. Further, this individual will serve as a key partner with the Office of Government Relations to develop and support legislation that places UMMC in the best position to expand services to all Mississippians and secure adequate financial support while doing so. This position reports to the Chief Financial Officer and works closely with the Health System Chief Financial Officer, Chief Medical Officer, Chief Revenue Cycle Officer, Chief of Care Management, and the Office of Government Relations.
Education & Experience
Bachelor's degree in Business Administration, Healthcare Administration, or related field and eight years of related experience in Managed Care contracting, healthcare finance and/or revenue cycle with at least three years of experiences in a senior management role. Must have experience with Managed Care or hospital contracting and risk-based payment methodologies such as shared savings and capitation as well as experience with complex financial modeling in Microsoft Excel. Master's degree in business, health care administration or related field preferred but not required.
Certifications, Licenses or Registration Required: NA
Knowledge, Skills & Abilities
In depth knowledge and progressively increasing leadership experience in Managed Care contracting and Payer Relations, ideally within a large integrated delivery system. Knowledge of most types of Managed Care agreements, including pricing arrangements and risk/quality arrangements. Strong negotiation skills and experience in crafting Managed Care agreements that deliver positive outcomes across all aspects of the delivery system. Expertise in innovative contracting and risk modeling approaches is essential. Proven ability to partner with multiple stakeholders to achieve operational objectives as well as develop policies and procedures compliant with state and federal regulations, NCQA standards and healthcare contract performance requirements. Leadership depth in the formation of high-performing teams; ability to provide coaching and mentorship of future talent. Through partnership with health plan and health system leaders, experience driving discipline, consistency, and execution of standardized initiatives and best practices. Ability to facilitate mechanisms to utilize pilots, measure results, and identify best practices to be used across the health system. Leadership skills in terms of strategic planning, assessment initiatives, and project management, computer, conceptual, and strong analytical skills. Verbal and written communication skills. Ability to report complex data in a clear, concise manner. Ability to work effectively with a wide range of constituencies. Ability to manage time and resources and work independently. Oversee the development and/or implementation of Managed Care policies and procedures. Work collaboratively with department staff and other team members throughout the organization. Must have strong Excel, Word, PowerPoint, Contract Management skills and willingness to pick up new tools as needed. Must have advanced knowledge of Managed Care reimbursement methodologies. Must have effective communication skills and comfortable working with internal and external executives at health plans, third party administrators, government entities, and other stakeholders.
Responsibilities

• Serves as a primary contact for payer and contracting issues and collaborates with the Chief Financial Officer and other senior executive leaders in negotiating Managed Care arrangements including reimbursement rates for the health system.
• Oversees and manages all phases of payer negotiations for hospital, practice plan and ancillary service areas.
• Represents UMMC in a professional and effective manner through weekly interactions with external contacts including but not limited to insurance companies, Medicaid officials in Mississippi and bordering states, Mississippi Hospital Association, and/or State legislators.
• Manages between three to five staff including directors, provider representatives, and analysts.
• Improves Managed Care arrangements for Medicare Advantage, Medicaid Managed Care and all commercial insurance products.
• In conjunction with the Chief Medical Officer, advises senior leadership of value-based care and pay for performance strategies across all payers. Works closely with operations, revenue cycle, case management, intake, credentialing personnel and physicians to manage contracting, billing and provider credentialing issues.
• In partnership with the Chief Medical Officer and clinical chairs, assists in designating key UMMC service lines as Centers of Excellence within multiple insurance plans.
• Monitors, analyzes and reports on payer scorecard metrics for UMMC's key Payer Relationships.
• Leads routine operational performance reviews with key UMMC payers to improve relationships, eliminate barriers to payment, identify and address payment shortfalls. Supervises pricing analytics on rate offers and makes recommendations to the senior team regarding contract rates and language, ensures that all contract negotiations track with the health system's Managed Care goals and strategies.
• Organizes all commercial payer contracts via a contract management database, keeping the system current and reporting any contract changes or new contracts to the appropriate stakeholders.
• Follows current Managed Care trends, code changes and fee schedules and reports any changes to the appropriate parties. Research and monitors insurance industry activities, healthcare reform, payer strategy and participates in legislative committees to gain knowledge in potential state and federal impacts. Develops and presents financial score cards, financial statements and financial analysis as required to payers and other stakeholders to promote the various programs at UMMC in terms of quality, performance, and other enhancements. Effectively partners with other members of the UMMC finance team to provide excellent service to stakeholders in the most efficient way possible. Identifies and communicates opportunities to improve the financial performance of the children's hospital. Analyzes monthly departmental budgeting and accounting reports to maintain expenditure controls and works with senior management and the department directors to ensure understanding of reports and the capabilities of the financial reporting system.
• The duties listed are general in nature and are examples of the duties and responsibilities performed and are not meant to be construed as exclusive or all-inclusive. Management retains the right to add or change duties at any time.

Physical and Environmental Demands
Requires working hours significantly beyond regularly scheduled hours, occasional travelling to offsite locations, constant work produced subject to precise measures of quantity and quality, occasional bending, occasional lifting, occasional climbing, occasional crawling, occasional crouching/stooping, occasional driving, occasional kneeling, occasional pushing/pulling, occasional reaching, constant sitting, occasional standing, occasional twisting, and occasional walking (occasional - up to 20%, frequent-from 21% to 50%, constant-51% or more).
Time Type:
Full time
FLSA Designation/Job Exempt:
Yes
Pay Class:
Salary
FTE %:
100
Work Shift:
Day
Benefits Eligibility:
Benefits Eligible
Grant Funded:
No
Job Posting Date:
03/4/2024
Job Closing Date (open until filled if no date specified):