Address
Form of work
SalaryKnows, understands, incorporates and demonstrates the mission, vision and values of Trinity Health in leadership behaviors, practices and decisions.
Develops and executes managed care and commercial payer strategies in conjunction with RHM CFOs and CEOs within region.
Negotiates regional managed care and commercial payer contracts utilizing consistent language and reimbursement methodologies and ensures that contracts are aligned with RHM strategies.
Establishes and maintains active, positive relationships with senior leadership at the hospitals, Revenue Excellence leadership, System Office leadership and Trinity Health Legal to ensure communication regarding service level performance and issue resolution.
Operationalizes and implements managed care contracts and contract updates at hospitals and within Revenue Excellence, including monitoring programs and denial management programs.
Communicates and implements payer policy changes with hospitals and Revenue Excellence. Monitors compliance with payer requirements and provides additional training when needed.
Monitors payer financial and operational performance and proactively implements payer corrective actions and improvement activities when required.
Establishes and maintains active, positive relationships with payer senior leadership with contracted payers within region. Identifies opportunities for payer collaboration and implements collaborative programs.
Serves as liaison between hospitals and payers within region.
Provides regular payer reporting package, including payer report cards, to hospital C-Suite leaders and Revenue Excellence leadership.
Develops and maintain market profiles of key payers, buyers and brokers to assist in developing strategies, decision making and proactively identifying managed care and health insurance trends.
Develops, implements and monitors payer pay for performance initiatives. Works with clinical leadership at hospitals to ensure maximum realization of revenue.
Manages and mentors payer contracting staff within region. Prepares budgets and manages use of resources within budget targets.
Maintains a working knowledge of applicable Federal, State and local laws/regulations; the Trinity Health Integrity and Compliance Program and Code of Conduct; as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior.
Our Commitment to Diversity and Inclusion
Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.
