Regional Director of Payer Strategies - Remote

Location: MMCIA - MercyOne Mercy Health Network Central IA

Time Type: Full time

Job Description

Employment Type:

Full time

Shift:

Description:

ESSENTIAL FUNCTIONS

1. Knows, understands, incorporates and demonstrates the mission, vision and values of Trinity Health in leadership behaviors, practices and decisions. 

2. Develops and executes managed care and commercial payer strategies in conjunction with RHM CFOs and CEOs within region.

3. Negotiates regional managed care and commercial payer contracts utilizing consistent language and reimbursement methodologies and ensures that contracts are aligned with RHM strategies.

4. 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.

5. Operationalizes and implements managed care contracts and contract updates at hospitals and within Revenue Excellence, including monitoring programs and denial management programs.

6. Communicates and implements payer policy changes with hospitals and Revenue Excellence. Monitors compliance with payer requirements and provides additional training when needed.

7. Monitors payer financial and operational performance and proactively implements payer corrective actions and improvement activities when required.

8. Establishes and maintains active, positive relationships with payer senior leadership with contracted payers within region. Identifies opportunities for payer collaboration and implements collaborative programs.

9. Serves as liaison between hospitals and payers within region.

10. Provides regular payer reporting package, including payer report cards, to hospital C-Suite leaders and Revenue Excellence leadership.

11. 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.

12. Develops, implements and monitors payer pay for performance initiatives. Works with clinical leadership at hospitals to ensure maximum realization of revenue.

13. Manages and mentors payer contracting staff within region. Prepares budgets and manages use of resources within budget targets.

14. 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.

LEADERSHIP COMPETENCIES 

As a Trinity Health Leader, the incumbent is expected to demonstrate leadership traits which support our Mission Statement and Core Values as identified below: 

Mission Statement: We, Trinity Health, serve together in the spirit of the Gospel as a compassionate and transforming healing presence within our communities.

Core Values:

• Reverence:  We honor the sacredness and dignity of every person.

• Commitment to Those who are Poor:  We stand with and serve those who are poor, especially those most vulnerable.

• Justice:  We foster right relationships to promote the common good, including sustainability of Earth.

• Stewardship: We honor our heritage and hold ourselves accountable for the human, financial and natural resources entrusted to our care.

• Integrity: We are faithful to those we say we are.

FULL TIME REMOTE POSITION

COMPENSATION RANGE: $176,596 - $291,384

MINIMUM QUALIFICATIONS:

1. Must possess a comprehensive knowledge of healthcare finance, managed care and insurer contracting, normally obtained through completion of a Bachelor’s in Business Administration, and eight to ten years of healthcare experience, a significant portion of which should include working with managed care and other payers. 

2. Master’s on Business Administration or Master’s in Health Administration preferred along with professional certification such as FHFMA, FACHE, or FAHM.

3. Must possess proven contract negotiation knowledge and skills.

4. Must possess strong analytical skills.

5. Must possess strong written and verbal communication skills.

6. Must be able to operate effectively in a collaborative, shared leadership environment.

7. Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health
 

 

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are 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, veteran status, or any other status protected by federal, state, or local law.