Address
Form of workDirector of Payer Relations
Boulder Community Health, Boulder, CO 80303
$56.43 - $94.05 an hour - Full Time
Boulder Community health is seeking a Director of Payer Relations. The Director of Payer Relations is responsible for delivering value to BCH by negotiating payer contracts that provide for BCH’s financial sustainability. This includes negotiating annual reimbursement increases that exceed BCH’s expense inflation, and subsidize unreimbursed costs for self-pay, charity, and governmental payers. The position optimizes payer contracts to minimize BCH’s administrative burden and denials. The position establishes both near and long-term strategies aligned to the organization’s vision related to effectiveness, efficiency, and growth to enhance the long-term health of the organization and the community. The Director of Payer Relations is responsible for building and maintaining positive and effective working and contracting relationships built on professionalism, trust, and integrity with insurance companies, employers, physicians, and managed care organizations to assure that patients in the BCH service area may access services at BCH as the preferred healthcare provider in the region. The position supports BCH’s growth by achieving highly aligned payer contractual relationships that steer patients to BCH through narrow networks and benefit plan design. In addition, the position is responsible for negotiating, implementing and monitoring all risk/capitation and non-risk payer contracts for the hospital, hospital owned physician practices, BCH joint ventures, Boulder Valley Care Network, Behavioral Health, Workers Compensation, Single Case Agreements, Laboratory, Occupational Medicine and Urgent Care contracts. In conjunction with the President and CEO (Chief Executive Officer) and CFO, develops managed care strategies and priorities for the hospital that support BCH’s overall strategic and operational goals.
Benefits:
•Health insurance, including a FREE employee only option
•Dental and Vision insurance
•BCH paid Life Insurance; Spouse and Dependent Life Insurance plans
•Short-term and Long-term disability coverage
•Health and Dependent Care Flexible Spending Accounts
•Retirement plan with BCH matching contributions, and discretionary lump sum contribution
•Paid Time Off
•Education assistance program
•Staff Support Initiatives such as Sound Baths, Meditation, Massages, and Reiki
•Free one-on-one retirement planning sessions
•Employee Assistance Program offering 8 free, confidential counseling sessions for you and your family
Qualifications
•Bachelor’s degree required; Master’s degree in Business preferred
•Five years of progressive management experience in a health care related setting
•Three years’ experience in a hospital setting
•Three years’ experience working directly with physicians
•Six years of experience negotiating with third party payer sources (managed care organizations, workers’ compensation insurance carriers, automobile insurance/no-fault insurance carriers and health insurance carriers)
Responsibilities
•Develops and implements organizational strategic plans as directed
•Develops and manages good working relationships between departments/users across the organization
•Utilizes appropriate technology to provide support for process improvement activities
•Supports and promotes ENCORE! Philosophy and mission of the hospital
•Is responsible for building strong working relationships and effective lines of communication, built on professionalism, trust, and integrity with insurance companies, hospital/physician joint ventures, employers, managed care organizations, physician groups and organizations, vendor partners, and employed physicians
•Is responsible for negotiating, implementing, and monitoring all risk/capitation and non-risk contracts for the hospital, hospital owned physician clinics, Boulder Valley Care Network, BCH Joint Ventures, Behavioral Health, Rehabilitation, , Workers Compensation, Single Case Agreements, Laboratory, Occupational Medicine and Urgent Care contracts
•Is responsible for contracting with managed care organizations for BCH’s employed physicians and serve as the single point of contact for contract related issues, assure adherence to the contract terms and attend/coordinate joint operating committee meetings with payor partners.
•Is responsible for establishing and monitoring performance-based compensation arrangements with payers that meet the hospital’s operational and strategic goals
About Boulder Community Health and Boulder, Colorado
Boulder Community Health’s vision is partnering to create and care for the healthiest community in the nation. We are a community owned-and-operated nonprofit health system dedicated to providing local access to high-quality medical care to our community in Boulder and surrounding areas.
We are known across Colorado for our clinical excellence in heart care, neurosurgery, stroke care, orthopedics and cancer care. We’re proud of our tradition of being an early adopter of new technologies and medical techniques that improve care for our patients. We are a Certified Level II Trauma Center with numerous awards and recognition including the 2023 Healthgrades Outstanding Patient Experience Award, 2022 Best Hospitals for Maternity Care from Leapfrog, Money Magazine and Newsweek and Boulder Weekly’s 2022 Best Hospital.
Nestled in the foothills of the Rocky Mountains, living and working in Boulder means enjoying the outdoors and natural beauty, bringing a fresh perspective to healthcare practice.
As an employee at Boulder Community Health, you will enjoy working in state-of-the-art facilities with competitive compensation and benefits, including health/dental/life, tuition reimbursement and an on-site fitness center. You also have access to an incredible Employee Wellness and Support program, employee activities, discounts and more!
EOE/Affirmative Action/Drug-free workplace.
BCH will never conduct interviews or ask for employment documents via text.
Boulder Community Health, Boulder, CO 80303
$56.43 - $94.05 an hour - Full Time
Boulder Community health is seeking a Director of Payer Relations. The Director of Payer Relations is responsible for delivering value to BCH by negotiating payer contracts that provide for BCH’s financial sustainability. This includes negotiating annual reimbursement increases that exceed BCH’s expense inflation, and subsidize unreimbursed costs for self-pay, charity, and governmental payers. The position optimizes payer contracts to minimize BCH’s administrative burden and denials. The position establishes both near and long-term strategies aligned to the organization’s vision related to effectiveness, efficiency, and growth to enhance the long-term health of the organization and the community. The Director of Payer Relations is responsible for building and maintaining positive and effective working and contracting relationships built on professionalism, trust, and integrity with insurance companies, employers, physicians, and managed care organizations to assure that patients in the BCH service area may access services at BCH as the preferred healthcare provider in the region. The position supports BCH’s growth by achieving highly aligned payer contractual relationships that steer patients to BCH through narrow networks and benefit plan design. In addition, the position is responsible for negotiating, implementing and monitoring all risk/capitation and non-risk payer contracts for the hospital, hospital owned physician practices, BCH joint ventures, Boulder Valley Care Network, Behavioral Health, Workers Compensation, Single Case Agreements, Laboratory, Occupational Medicine and Urgent Care contracts. In conjunction with the President and CEO (Chief Executive Officer) and CFO, develops managed care strategies and priorities for the hospital that support BCH’s overall strategic and operational goals.
Benefits:
•Health insurance, including a FREE employee only option
•Dental and Vision insurance
•BCH paid Life Insurance; Spouse and Dependent Life Insurance plans
•Short-term and Long-term disability coverage
•Health and Dependent Care Flexible Spending Accounts
•Retirement plan with BCH matching contributions, and discretionary lump sum contribution
•Paid Time Off
•Education assistance program
•Staff Support Initiatives such as Sound Baths, Meditation, Massages, and Reiki
•Free one-on-one retirement planning sessions
•Employee Assistance Program offering 8 free, confidential counseling sessions for you and your family
Qualifications
•Bachelor’s degree required; Master’s degree in Business preferred
•Five years of progressive management experience in a health care related setting
•Three years’ experience in a hospital setting
•Three years’ experience working directly with physicians
•Six years of experience negotiating with third party payer sources (managed care organizations, workers’ compensation insurance carriers, automobile insurance/no-fault insurance carriers and health insurance carriers)
Responsibilities
•Develops and implements organizational strategic plans as directed
•Develops and manages good working relationships between departments/users across the organization
•Utilizes appropriate technology to provide support for process improvement activities
•Supports and promotes ENCORE! Philosophy and mission of the hospital
•Is responsible for building strong working relationships and effective lines of communication, built on professionalism, trust, and integrity with insurance companies, hospital/physician joint ventures, employers, managed care organizations, physician groups and organizations, vendor partners, and employed physicians
•Is responsible for negotiating, implementing, and monitoring all risk/capitation and non-risk contracts for the hospital, hospital owned physician clinics, Boulder Valley Care Network, BCH Joint Ventures, Behavioral Health, Rehabilitation, , Workers Compensation, Single Case Agreements, Laboratory, Occupational Medicine and Urgent Care contracts
•Is responsible for contracting with managed care organizations for BCH’s employed physicians and serve as the single point of contact for contract related issues, assure adherence to the contract terms and attend/coordinate joint operating committee meetings with payor partners.
•Is responsible for establishing and monitoring performance-based compensation arrangements with payers that meet the hospital’s operational and strategic goals
About Boulder Community Health and Boulder, Colorado
Boulder Community Health’s vision is partnering to create and care for the healthiest community in the nation. We are a community owned-and-operated nonprofit health system dedicated to providing local access to high-quality medical care to our community in Boulder and surrounding areas.
We are known across Colorado for our clinical excellence in heart care, neurosurgery, stroke care, orthopedics and cancer care. We’re proud of our tradition of being an early adopter of new technologies and medical techniques that improve care for our patients. We are a Certified Level II Trauma Center with numerous awards and recognition including the 2023 Healthgrades Outstanding Patient Experience Award, 2022 Best Hospitals for Maternity Care from Leapfrog, Money Magazine and Newsweek and Boulder Weekly’s 2022 Best Hospital.
Nestled in the foothills of the Rocky Mountains, living and working in Boulder means enjoying the outdoors and natural beauty, bringing a fresh perspective to healthcare practice.
As an employee at Boulder Community Health, you will enjoy working in state-of-the-art facilities with competitive compensation and benefits, including health/dental/life, tuition reimbursement and an on-site fitness center. You also have access to an incredible Employee Wellness and Support program, employee activities, discounts and more!
EOE/Affirmative Action/Drug-free workplace.
BCH will never conduct interviews or ask for employment documents via text.
