WellSpan Health
General Summary
Participates in third party payor contract negotiations and manages contract performance compliance for the System to ensure fair and adequate payment rates, operational terms that are acceptable and manageable, and payor compliance with contract financial and operational terms. Manages and develops support processes for the effective performance monitoring and negotiation of contracts. Leads a team of Payor Contract Negotiators.
Duties and Responsibilities
Manages all new as well as timely renewals of System contracts, including new hospital additions as applicable, in accordance with System Care Contracting Team. Includes all traditional medical components (hospital, WMG, Apple Hill, rehab/surgery hospital, home infusion, VNA, DME) and Value-Based Purchasing.
Collaborates with contracting leadership to identify and understand challenging operational issues with payor contract compliance and develops and modifies contracting language to be incorporated into future contracts or contract amendments to minimize operational difficulties. Engages on contract negotiations to ensure operational success and reduction in revenue balances. Collaborates on organizational finance tools, annual budget, and five-year outlooks.
Collaborates with leadership on identifying opportunities and challenges related to Value-Based Purchasing agreements and revenue opportunities
Manages the development and maintenance of the System's preferred standard contracting terms to be incorporated into new or revised contracts.
Manages and develops processes to ensure the System is compliant with contract notification terms, including: annual price increases, change in services, change in sites, etc. Ensures clear and timely communication and updates provided to analytics team.
Develops and maintains system payor contract summary with key details, including line of business, effective date, end date, termination notice period, COLA/CM date and percentages.
Develops processes, to collect and maintain available market information regarding market payment rates and methods for various types of managed care payors: including Medicare, Medical Assistance, & Commercial managed care payors.
Oversees working with appropriate ancillary department personnel in the maintenance and execution of payor contracts (BHU, Rx, Dental, lab, WC).
Leads the weekly team huddles, monthly team meetings, individual one on one meetings with direct reports, monthly Payor Contracting Update meetings for internal matrix partners.
Maintains a strong knowledge of all pertinent governmental regulations that pertain to both payor contracts and hospital operations (i.e., Act 68, HIPAA, Surprise Billing) ensuring appropriate compliance requirements are kept by departmental personnel as applicable.
Assists the VP of Payor Contracting and Population Health in projects, presentations, and negotiation updates.
Summarizes negotiations (starting point, updates, and final results) for a variety of leadership forums utilizing presentation skills and tools.
Manages contract terminations, including internal communications and matrix partner collaborations.
Responsible for the direct leadership and mentorship of Payor Contracting Negotiators.
Qualifications
Minimum Education:
Bachelors Degree Finance, Healthcare Administration, or related field Required
Masters Degree Business or Healthcare Administration Preferred
Work Experience:
10+ years Experience in Third party payor contracting, Accounting, Patient Accounting, or Government Regulations Required and
Supervisory experience. Required
Healthcare reimbursement, third party payor or regulatory experience. Preferred
Knowledge, Skills, and Abilities:
Excellent computer skills
Excellent oral and written communication skills
Data and analytics knowledge
Benefits Offered:
Comprehensive health benefits
Flexible spending and health savings accounts
Retirement savings plan
Paid time off (PTO)
Short-term disability
Education assistance
Financial education and support, including DailyPay
Wellness and Wellbeing programs
Caregiver support via Wellthy
Childcare referral service via Wellthy
WellSpan Health's vision is to reimagine healthcare through the delivery of comprehensive, equitable health and wellness solutions throughout our continuum of care. As an integrated delivery system focused on leading in value-based care, we encompass more than 2,300 employed providers, 250 locations, nine award-winning hospitals, home care and a behavioral health organization serving central Pennsylvania and northern Maryland. Our high-performing Medicare Accountable Care Organization (ACO) is the region's largest and one of the best in the nation. With a team 23,000 strong, WellSpan experts provide a range of services, from wellness and employer services solutions to advanced care for complex medical and behavioral conditions. Our clinically integrated network of 3,000 aligned physicians and advanced practice providers is dedicated to providing the highest quality and safety, inspiring our patients and communities to be their healthiest.
Quality of Life
Founded in 1741, the city of York is considered by many as the first capital of the United States. The Articles of Confederation were signed by the Second Continental Congress here in 1777. Its beautifully restored historic district is an architectural treasure. While York retains its farming and manufacturing heritage, at its heart York is a thriving cultural community that has attracted creative talent and innovative entrepreneurial investors from across the nation.
Life in York County offers affordable housing, options for higher education, a thriving arts and cultural community, historical attractions, parks and recreational resources, semi-professional baseball team, fine dining and more - within an easy drive of major East Coast cities.
York County residents can find local employment in healthcare, manufacturing, technology, agricultural and service sectors. (Patient population: 445,000)
WellSpan Health is an Equal Opportunity Employer. It is the policy and intention of the System to maintain consistent and equal treatment toward applicants and employees of all job classifications without regard to age, sex, race, color, religion, sexual orientation, gender identity, transgender status, national origin, ancestry, veteran status, disability, or any other legally protected characteristic.
Participates in third party payor contract negotiations and manages contract performance compliance for the System to ensure fair and adequate payment rates, operational terms that are acceptable and manageable, and payor compliance with contract financial and operational terms. Manages and develops support processes for the effective performance monitoring and negotiation of contracts. Leads a team of Payor Contract Negotiators.
Duties and Responsibilities
Manages all new as well as timely renewals of System contracts, including new hospital additions as applicable, in accordance with System Care Contracting Team. Includes all traditional medical components (hospital, WMG, Apple Hill, rehab/surgery hospital, home infusion, VNA, DME) and Value-Based Purchasing.
Collaborates with contracting leadership to identify and understand challenging operational issues with payor contract compliance and develops and modifies contracting language to be incorporated into future contracts or contract amendments to minimize operational difficulties. Engages on contract negotiations to ensure operational success and reduction in revenue balances. Collaborates on organizational finance tools, annual budget, and five-year outlooks.
Collaborates with leadership on identifying opportunities and challenges related to Value-Based Purchasing agreements and revenue opportunities
Manages the development and maintenance of the System's preferred standard contracting terms to be incorporated into new or revised contracts.
Manages and develops processes to ensure the System is compliant with contract notification terms, including: annual price increases, change in services, change in sites, etc. Ensures clear and timely communication and updates provided to analytics team.
Develops and maintains system payor contract summary with key details, including line of business, effective date, end date, termination notice period, COLA/CM date and percentages.
Develops processes, to collect and maintain available market information regarding market payment rates and methods for various types of managed care payors: including Medicare, Medical Assistance, & Commercial managed care payors.
Oversees working with appropriate ancillary department personnel in the maintenance and execution of payor contracts (BHU, Rx, Dental, lab, WC).
Leads the weekly team huddles, monthly team meetings, individual one on one meetings with direct reports, monthly Payor Contracting Update meetings for internal matrix partners.
Maintains a strong knowledge of all pertinent governmental regulations that pertain to both payor contracts and hospital operations (i.e., Act 68, HIPAA, Surprise Billing) ensuring appropriate compliance requirements are kept by departmental personnel as applicable.
Assists the VP of Payor Contracting and Population Health in projects, presentations, and negotiation updates.
Summarizes negotiations (starting point, updates, and final results) for a variety of leadership forums utilizing presentation skills and tools.
Manages contract terminations, including internal communications and matrix partner collaborations.
Responsible for the direct leadership and mentorship of Payor Contracting Negotiators.
Qualifications
Minimum Education:
Bachelors Degree Finance, Healthcare Administration, or related field Required
Masters Degree Business or Healthcare Administration Preferred
Work Experience:
10+ years Experience in Third party payor contracting, Accounting, Patient Accounting, or Government Regulations Required and
Supervisory experience. Required
Healthcare reimbursement, third party payor or regulatory experience. Preferred
Knowledge, Skills, and Abilities:
Excellent computer skills
Excellent oral and written communication skills
Data and analytics knowledge
Benefits Offered:
Comprehensive health benefits
Flexible spending and health savings accounts
Retirement savings plan
Paid time off (PTO)
Short-term disability
Education assistance
Financial education and support, including DailyPay
Wellness and Wellbeing programs
Caregiver support via Wellthy
Childcare referral service via Wellthy
WellSpan Health's vision is to reimagine healthcare through the delivery of comprehensive, equitable health and wellness solutions throughout our continuum of care. As an integrated delivery system focused on leading in value-based care, we encompass more than 2,300 employed providers, 250 locations, nine award-winning hospitals, home care and a behavioral health organization serving central Pennsylvania and northern Maryland. Our high-performing Medicare Accountable Care Organization (ACO) is the region's largest and one of the best in the nation. With a team 23,000 strong, WellSpan experts provide a range of services, from wellness and employer services solutions to advanced care for complex medical and behavioral conditions. Our clinically integrated network of 3,000 aligned physicians and advanced practice providers is dedicated to providing the highest quality and safety, inspiring our patients and communities to be their healthiest.
Quality of Life
Founded in 1741, the city of York is considered by many as the first capital of the United States. The Articles of Confederation were signed by the Second Continental Congress here in 1777. Its beautifully restored historic district is an architectural treasure. While York retains its farming and manufacturing heritage, at its heart York is a thriving cultural community that has attracted creative talent and innovative entrepreneurial investors from across the nation.
Life in York County offers affordable housing, options for higher education, a thriving arts and cultural community, historical attractions, parks and recreational resources, semi-professional baseball team, fine dining and more - within an easy drive of major East Coast cities.
York County residents can find local employment in healthcare, manufacturing, technology, agricultural and service sectors. (Patient population: 445,000)
WellSpan Health is an Equal Opportunity Employer. It is the policy and intention of the System to maintain consistent and equal treatment toward applicants and employees of all job classifications without regard to age, sex, race, color, religion, sexual orientation, gender identity, transgender status, national origin, ancestry, veteran status, disability, or any other legally protected characteristic.