Dir Payor Relations & Contract Performance

PURPOSE AND SCOPE:

Oversees and directs the functions and activities of strategic planning, evaluation, coordination, and implementation of various managed health care programs (HMO, PPO, POS, etc.) for Payor Relations. Oversees contractual relationships with managed care organizations and other third party payors regarding rate structures for services, clinical and financial reporting obligations, establishment of other business terms per FMCNA guidelines, and contract maintenance such as facility list updates and amendments. 

PRINCIPAL DUTIES AND RESPONSIBILITIES:

• Provide strategic leadership of short- and long-term goals through the use of thoughtful techniques in the communication of the company's mission and core values as a means to implement positive change and/or create organizational structure within the assigned business unit(s).
• Lead operational efforts through subordinates to complete the administration of business processes and services to ensure the operations effective achievement of goals within the assigned business unit(s).
• Direct and control the broad activities of the business unit(s) through the interpretation, application and implementation of company-wide policies and processes appropriate to the functional area(s).
• Provide leadership, guidance and coaching for all direct reports to maintain an engaged and productive workforce; partnering with Human Resources on employee matters.
• Collaborate with employees in the establishment of clear and concise development plans to ensure succession planning and the advancement of future leaders within the organization.
• Technically proficient leader in the specific department and knowledge of industry practice and business principles.  Has a large range within a department or multiple departments.
• A strong tactical decision-maker; role primarily focuses on tactical execution.  Handles unforeseen issues.
• Works on complex issues where analysis of situations or data requires an in-depth knowledge of organizational objectives.  Has significant program or project responsibility generally within the function.
• Implements strategic policies when selecting methods, techniques, and evaluation criteria for obtaining results.
• Decisions have an extended impact on work processes and outcomes.  Erroneous decisions will result in critical delay(s) in schedules and/or unit operations, and may jeopardize overall business activities.
• Requires the ability to change the thinking of, or gain acceptance from, others in sensitive situations, without damage to the relationship.  Regularly interacts with senior management or executive levels on matters concerning several functional areas, divisions, and/or customers.
• Interacts frequently with internal departments and external customers/vendors; particularly in problem resolution.  Responsible for hiring, coaching and counseling employees, including performance reviews, disciplinary action and terminations.
• Provide strategic insight on complex industry issues and lead critical initiatives across Fresenius and the payor community
• Identify, analyze and interpret key industry trends to identify strategic growth opportunities, provide strategic recommendations and negotiate with payor partners.
• Develop and maintain strategic relationships with a multitude of payors including PBMs, Health Plans, Regional Health Plans, Government Payors and other large payors
• Oversees contractual relationships with managed care organizations and other third party payors regarding rate structures for services, clinical and financial reporting obligations, establishment of other business terms per FMCNA guidelines, and contract maintenance such as facility list updates and amendments. 
• Develop and foster strong, positive working relationships with existing and future payors to maximize opportunities and promote the company's value proposition.
• Negotiates contractual relationships with managed care organizations and other third party payors, as needed.
• Requests or approves in-depth amendments to or extensions of contracts.
• Researches, maintains, and updates payor contracts for assigned accounts.
• Serve as subject matter expert on complex insurance and payor related activities with the management and executive teams
• Recommends strategies to improve overall performance, quality of service, and suggests changes in working conditions to increase efficiency. 
• Presents high level contract proposals and market and industry analyses to internal parties and responds to requests for proposals from third party payors.
• Lead complex negotiations, align operating and strategic activities and processes
• Reviews and analyzes complex potential contracts for financial effect, cost benefit, and utilization.
• Develop, implement, and manage various programs that enhance payor partnerships, grow Fresenius share and profitability. Programs include but not limited to preferred networks, MTM, value based reimbursement, etc.
• Assist with and maintain a permanent record of all major payor contract negations. Once a contract is negotiated, assist in administering implementation protocols to ensure a smooth and timely operationalizing of the contract.
• Maintains existing contracts and implements new contracts, serving as the primary point of contact for state and regional plans. 
• Ensures all contracts and specific data is maintained timely and accurately in the tracking system so all information can be easily referenced.
• Review and comply with the Code of Business Conduct and all applicable company policies and procedures, local, state and federal laws and regulations.
• Ensure all employees within the assigned team(s) understand and comply with the Code of Business Conduct and all applicable company policies and procedures, local, state and federal laws and regulations; establishing and maintaining effective internal systems and controls to promote compliance.
• Provide technical guidance.
• Assist with various projects as assigned.
• Other duties as assigned. 

Additional responsibilities may include focus on one or more departments or locations.  See applicable addendum for department or location specific functions.

 

PHYSICAL DEMANDS AND WORKING CONDITIONS:

• The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Day to day work includes desk and personal computer work and may include interaction with managed care organizations, patients, staff, facilities and physicians. 
• The position may require up to 25% travel

SUPERVISION:

• May be responsible for the direct supervision of various levels of Payor Relations staff.

EDUCATION:

• Bachelor's Degree required; Advanced Degree preferred

EXPERIENCE AND REQUIRED SKILLS:             

• 6+ years' related experience in direct contract negotiation
• 3+ years' experience as a Manager; or 3+ years' experience in a senior managerial role.
• Demonstrated experience managing one or more departments.
• Strong management skills with the ability to lead cohesive and productive teams.
• Strong interpersonal skills with the ability to communicate with all levels of management through diplomacy and tact.
• Direct operational experience in a multiple site outpatient facility setting including profit and loss responsibility strongly preferred.
• Competency with standard business computer systems.
• Ability to manage databases and provide analysis.
• Ability to reprioritize based on other priorities, deadlines, work flow, and work volume.
• Excellent verbal and written communication skills.

Fresenius Medical Care maintains a drug-free workplace in accordance with applicable federal and state laws.

EOE, disability/veterans