Director - Payor Contracting Job at Advocate Health Care (Charlotte)

Associate Director Managed Care Contracting

Responsible for managed care portfolio performance for assigned payors. Implemen...

Location

United States , Charlotte

Salary:

51.05 - 76.60 USD / Hour

Advocate Health Care

Expiration Date

Until further notice

Requirements

Bachelor's degree required
Master's degree preferred (MBA or MHA preferred)
Minimum of 5 years experience as a contract negotiator with a large provider or 7 years small provider or payor experience as a contract negotiator with a Bachelor's degree
OR Minimum of 3 years experience as a contract negotiator with a large provider or 5 years small provider or payor experience as a contract negotiator with a Master's degree

Job Responsibility

Assists in the development and implementation of the System's strategies and objectives related to managed care contracting for assigned Managed Care Organizations
Responsible for rate and language negotiation of assigned payor agreements
Assists in negotiations and maintenance of collaborative/value based managed care agreements including but not limited to provider tiering and performance reporting
Monitors, regularly reviews and report financial and operational performance of assigned payor contracts versus expectations
Gathers and analyzes data and apply methodologies
Creates and implements managed care contracting policies and procedures to maximize System performance in managed care relationships
Provides System with accurate and current managed care market intelligence

What we offer

Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program

Fulltime

Patient Financial Specialist Senior

The associate is responsible for the duties and services that are of a support n...

Location

United States , Irving

Salary:

Not provided

CHRISTUS Health

Expiration Date

Until further notice

Requirements

HS Diploma or equivalent years of experience required
3-5 years of experience preferred
Experience calculating expected reimbursement according to payer regulations and/or contracts required
Experience with Commercial, Medicare, and Medicaid reimbursement
Medicare, Medicaid, VA, Tricare billing and collections processes and regulations preferred
College education, previous Insurance Company claims experience and/or health care billing trade school education may be considered in lieu of formal hospital experience
Prefer hands-on experience with Medicare Remote (FISS) – DDE
Must have in-depth knowledge and ability to maneuver efficiently through Patient Accounting Systems, Document Imaging, Databases, etc.
Must have understanding of Medicare and Commercial contract language
Must have good technical aptitude working with a variety of MS Office products (Word, Excel, PowerPoint, Outlook) and/or ability to learn and develop more advance skills with the various applications

Job Responsibility

Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders
Performs Revenue Cycle functions in a manner that meets or exceeds CHRISTUS Health key performance metrics
Ensures PFS departmental quality and productivity standards are met
Functions as a subject matter expert in support of other PFS team members and other departments/facilities within the CHRISTUS Health network
Demonstrates a good understanding and has the ability to interact with the payer to verify coverage, submit claims, and follow up on appeals, underpayments, short pays or payment disputes for resolution
Investigate and resolve complex payment denials inclusive of correcting errors and supplying additional required information to facilitate collection of reimbursement / additional reimbursement
Ability to analyze, recognize, and resolve issues utilizing strategic thinking
Work with a variety of payers
Adapt to process and procedure evaluations and improvements, support continuous change, and willingly manage special projects in addition to normal workload and other duties as assigned
Responsible for professional and effective written and verbal communication with both internal and external customers

Fulltime

Clinical Lab AR Manager

Headquartered in Phoenix, IMS Care Center is a team of 500 employees and a physi...

Location

United States , Phoenix

Salary:

Not provided

Integrated Medical Services, Inc.

Expiration Date

Until further notice

Requirements

Bachelor's degree in healthcare administration, finance, business administration, or a closely related field
3–5+ years' experience managing medical billing or accounts receivable, with specific experience in laboratory specific billing required
High proficiency in medical coding systems (CPT, ICD-10), electronic health record (EHR) software, and clearinghouses
Ability to maintain records, prepare reports and conduct correspondence related to the work
Ability to communicate with others, both verbally and in writing
The ability to work in a constant state of alertness and in a safe manner

Job Responsibility

Manage the end-to-end processing of laboratory invoices, tracking 'aging buckets' (outstanding payments over 30, 60, or 90 days), and maximizing cash flow
Manage revenue cycle by identifying insurance companies rejecting laboratory claims (e.g., incorrect diagnosis coding or lack of medical necessity) and leading teams to correct and appeal the claims
Ensure all billing practices are strictly aligned with healthcare laws, payer contracts, and government regulations such as HIPAA
Manage payor and system reconciliation to resolve complex payment discrepancies between the lab's information system (LIS) and various health insurance portals
Oversee all project stages, including scope definition, planning, and task management, ensuring that deliverables meet quality standards and are completed on schedule
Serve as the primary point of contact for sponsors, physicians, and internal laboratory functions, lead kick-off meetings and provide regular status updates to ensure alignment
Proactively monitor study budgets, manage purchase orders, and track expenses to ensure financial performance
Ensure all activities strictly adhere to industry standards like Good Laboratory Practice (GLP), ISO, or regulations in collaboration with the Medical Director of the Lab
Independently identify and mitigate potential risks, such as timeline delays, or supply chain issues
Pull reports on tests performed and denials, and work with revenue cycle team and operations to address denials, along with OBL reports

Fulltime

Value And Access Insights Associate Director, Obesity

In this vital role you will partner with Global and US Value & Access, US Covera...

Location

United States , Thousand Oaks

Salary:

170719.95 - 230974.05 USD / Year

Amgen

Expiration Date

Until further notice

Requirements

Doctorate degree and 3 years in Business Administration, Accounting, Finance, Engineering (any), Science (any), Statistics or related field
Master's degree and 5 years in Business Administration, Accounting, Finance, Engineering (any), Science (any), Statistics or related field
Bachelor's degree and 7 years in Business Administration, Accounting, Finance, Engineering (any), Science (any), Statistics or related field
Associate's degree and 12 years in Business Administration, Accounting, Finance, Engineering (any), Science (any), Statistics or related field
High school diploma / GED and 14 years in Business Administration, Accounting, Finance, Engineering (any), Science (any), Statistics or related field

Job Responsibility

Build upon existing, targeted payer control deep-dive analyses (e.g. CVS Zepbound exclusion, oral steps) and integrate into weekly NBRx/TRx tracking
Evaluate partner capabilities to generate and share actionable pricing, coverage, demand and affordability data to inform coverage and pricing strategies for reimbursed segment
Build Obesity-specific modules within US V&A contracting deal modeling platforms (Contracting-IQ), building on efforts in 1H ’26 to incorporate Obesity market data into the analog library
Triangulate data sources (Clarivate, MMIT, partner data) to refine employer segmentation and targeting
Design and build Employer-specific modules within Contracting-IQ to support direct employer contracting
Build CAP-AI for Obesity for dynamic copay / patient access support, including interplay with cash
Partner with Payer Marketing and Pricing/Contracting and Brand Marketing teams to build and prioritize analytics and insights plan in support of value and access strategy for MariTide
Understand pharmaceutical ecosystem and data sets including medical and pharmacy claims (ex. IQVIA LAAD, Symphony Claims), prescription (ex. IQVIA NPA), outlet (ex. IQVIA DDD) and Payor Coverage (MMIT, Clarivate)

What we offer

A comprehensive employee benefits package, including a Retirement and Savings Plan with generous company contributions, group medical, dental and vision coverage, life and disability insurance, and flexible spending accounts
A discretionary annual bonus program, or for field sales representatives, a sales-based incentive plan
Stock-based long-term incentives
Award-winning time-off plans
Flexible work models where possible

Fulltime

Director Provider Account Management

JOB SUMMARY: Responsible for leading growth, maintenance and implementation of c...

Location

United States

Salary:

86000.00 - 141800.00 USD / Year

One Call

Expiration Date

Until further notice

Requirements

Bachelor’s degree (B.A. or B.S.) and/or a Master’s degree (M.A., S. or M.B.A.) in Business or Accounting
Minimum of five (5) years of experience in health care services
Three (5) years of management experience
Five (5) years of experience in provider relations and/or Account/vendor Management, or a related area
A combination of equivalent education or experience
Minimum of 10 years of successful provider contracting and/or Account Management experience including: Excellent provider relations experience and thorough knowledge of managed care practices and provider contracting, either in a provider or payor capacity
Extensive experience and thorough knowledge of provider reimbursement methodologies, financial modeling, business analytics and reporting, provider coding and billing procedures, and related concepts and terminology
Thorough knowledge of insurance terminology, concepts, and benefits issues, including actuarial and underwriting relationships to provider rates and services, member benefits, and cost sharing attributes
Excellent verbal communication skills, including listening effectively, persuasive negotiation skills, and communicating strategic and technical issues to individuals and in presentations to groups
Ability to comprehend and interpret managed care contract terminology and thorough knowledge of quantitative analysis related to provider reimbursement

Job Responsibility

Direct team activities while working with the manager on items, including Key Account updates, cross functional projects, savings initiatives, revenue growth, and new product opportunities
Guide the manager in working with team to maintain critically important providers, integrated provider systems, and provider networks that support business needs and align with corporate priorities while working to identify gaps in coverage with a plan to address
Support the manager leading the team in building and maintaining productive relationships with key accounts while enforcing One Calls value propositions in the marketplace
Lead Managers in reporting and forecasting key operational functions and data analyses necessary to support provider contracts/current key accounts so the One Call’s work units can create complete, timely, and accurate workflows and support for provider networks and contractual provisions working with team to ensure they are as effective as possible
Meet with managers to discuss/report up on any potential regulatory changes, analyze contractual language periodically, as well as the parties' obligations and overall relationships to ensure agile response to market conditions, necessary regulatory compliance, and adequate network access
Support manager to share and maintain thorough knowledge of existing and emerging contract arrangements, regulations, and pricing trends
renegotiate contracts where improvements are needed
Lead and meet with managers on regular cadence to monitor contract performance of providers
analyze relevant reports
identify reporting, administration, reconciliation, and systems opportunities for improvement

Fulltime

Senior Director National Accounts

CSL is a leading global biotechnology company with a dynamic portfolio of lifesa...

Location

United States

Salary:

238000.00 - 307000.00 USD / Year

The Muse

Expiration Date

Until further notice

Requirements

B.A. or B.S. Degree required
12+ years of experience in the biotech industry, preferably rare & orphan disease medicines
5+ years of payor experience including channel account management
Experience in product pharmaceutical marketing and/or sales
Prior success in leading, managing & developing teams, including remote personnel
Demonstrated success in achieving formulary coverage for branded specialty products
Demonstrated success with account management across channels, including specialty pharmacies, GPOs, integrated health systems & payers
Knowledge of relevant legal, compliance & regulatory requirements

Job Responsibility

Provide input & customer segment perspective into the development of market access (payor / channel) strategies for all key brands
Provide input into brand value platform development & ensure that account managers are informed and trained on the delivery of the value proposition / core messaging to CSL accounts
Maintain a clear understanding of brand business objectives with a focus on channel optimization
Build & maintain relationships with external CSL customers, including commercial & public sector payors & aligned specialty pharmacies
Drives profitable access for CSL brands across all relevant payors within approved guidelines
Monitors the external environment, customers and competitors to identify opportunities for CSL regarding brand differentiation & access enhancement
Owns account deployment decisions, account strategies, account-level business plan development & NAD direction to drive the CSL business
Participate in the Contract Review Committee & Pricing Committee, collaborating in the development of recommendations for consideration in conjunction with US Market Access, Finance, Legal & Marketing
Works with internal & external business partners to ensure account-specific objectives are achieved
Develops & maintains contacts within the industry to obtain environmental, competitive & product-specific insights

What we offer

Health Insurance
Dental Insurance
Vision Insurance
Life Insurance
Short-Term Disability
Long-Term Disability
FSA
HSA
Mental Health Benefits
Adoption Leave

Fulltime

Managed Care Senior Manager

Corporate level manager responsible for deploying and contributing to strategic ...

Location

United States , Fort Lauderdale

Salary:

Not provided

Memorial Healthcare System

Expiration Date

Until further notice

Requirements

Bachelors
Five (5) years contracting experience with three (3) years contracting for hospital, professional services, ancillary facilities or specialty networks

Job Responsibility

Execute, contribute and manage complex legal, financial and operational contract language negotiations in concert with the Director of Managed Care or independently as applicable to the negotiation
Execute contracting strategies for all service lines in Memorial Hospitals, MHS employed physicians, transplant programs, and ancillary services of the fully integrated healthcare delivery system and its joint owned or joint ventured entities for fee for service and value based arrangements
Direct and analyze financial performance, reports and models, quality metrics and cost savings for negotiations with national and regional payors
Plan and monitor activities of staff and team members including hiring, orienting, training, mentoring, continuing education, evaluating, coaching and disciplinary actions
Enhance, estimate and preserve net revenues
Assure financial viability of contracts through financial analysis and forecasting in conjunction with Financial Analyst(s), contract negotiations and issue resolution
Execute strategies and guides operations to protect and build market share
Interface with managed care plans on claim reconciliations, trended issues and operational projects
Determine root cause and seek resolution
Evaluate payor assessments of overpayments and effectively dispute or resolve for settlement

Fulltime

Managed Care Manager - Contracts

Corporate level manager responsible for deploying and contributing to strategic ...

Location

Hollywood

Salary:

Not provided

Memorial Healthcare System

Expiration Date

Until further notice

Requirements

Bachelors (Required)
5 years contracting experience with 3 years contracting for hospital, professional services, ancillary facilities or specialty networks

Job Responsibility

Execute and manage legal, financial and operational contract language negotiations in concert with the Director of Managed Care
Contribute and coordinate negotiations of ancillary services in concert with the Director of Managed Care
Enhance, estimate and preserve net revenues and build market share
Escalate, monitor and manage operational issues from Managed Care Revenue Optimization, Accounts Receivable Management or Joint Operations
Address all single-case negotiations with non-contracted payors
Respond to insurance industry activities, healthcare reform, payer strategies, emerging market demands and legislative considerations

Fulltime

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Director - Payor Contracting

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