Director, Large Accounts | Remote
This position is responsible for developing, managing, and leading the day-to-day activities associated with managed care contracting for both fee for service and risk agreements within a specified market. The work of the incumbent will be focused on developing and implementing new insurance and risk-based contracts and on evaluating, monitoring, and maintaining existing insurance and risk-based contracts. The contracts will primarily include facilities, ancillaries, physicians, PHO’s, and clinically integrated networks for a specific state where Bon Secours Mercy Health operates.
Essential Job Functions
Leads assigned negotiations of fee for service, and value based (including risk, pay for performance) contracts for all Bon Secours Mercy Health in a specific state for Bon Secours Mercy Health. This scope of contract management will range in revenues between $500m and $1b in commercial revenues.
Develops innovative, mutually beneficial economic and clinical alignment agreements that leverage BSMH’s clinically integrated networks and collaborates with physician and operational leadership of Pop Health.
Employing a strong financial background and critical thinking skills, analyzes and facilitates the financial analyses and contract language negotiation for hospitals and physicians necessary to support the accuracy and profitability of fee for service and value based managed care contracting initiatives.
Plays a key role in Payer relationships to set the stage for future initiatives and to support existing agreements, both fee for service and value based.
Coordinate initiatives and with cross functional teams including individual markets and their leadership teams, Marketing & Communications, Finance, Revenue Cycle & Pop Health. Works closely with these groups to develop strategic plans for payers and markets including narrow network alternatives to grow attributed lives.
Work within the markets as necessary on the standardization of processes, reporting and approaches to payer contracting, payer relationships, network participation and other strategic project from time to time.
Participates in short- and long-term projects, as needed.
Maintains knowledge and understanding of the current trends and developments in healthcare reimbursement and development of specific payer strategies, including investigation of new business opportunities, regulations, standards and directives regarding governmental/third party agencies (Medicare & Medicaid) and/or third party leads assigned negotiations of fee for service, and value based (including risk, pay for performance) contracts for all Bon Secours Mercy Health in a specific state for Bon Secours Mercy Health. This scope of contract management will range in revenues between $500m and $1b in commercial revenues.
Develops innovative, mutually beneficial economic and clinical alignment agreements that leverage BSMH’s clinically integrated networks and collaborates with physician and operational leadership of Pop Health.
Employing a strong financial background and critical thinking skills, analyzes and facilitates the financial analyses and contract language negotiation for hospitals and physicians necessary to support the accuracy and profitability of fee for service and value based managed care contracting initiatives.
Plays a key role in Payer relationships to set the stage for future initiatives and to support existing agreements, both fee for service and value based.
Coordinate initiatives and with cross functional teams including individual markets and their leadership teams, Marketing & Communications, Finance, Revenue Cycle & Pop Health. Works closely with these groups to develop strategic plans for payers and markets including narrow network alternatives to grow attributed lives.
Work within the markets as necessary on the standardization of processes, reporting and approaches to payer contracting, payer relationships, network participation and other strategic project from time to time.
Participates in short and long term projects, as needed.
Maintains knowledge and understanding of the current trends and developments in healthcare reimbursement and development of specific payer strategies, including investigation of new business opportunities, regulations, standards and directives regarding governmental/third party agencies (Medicare & Medicaid) and/or third-party payers.
Adheres to the standards and policies of the Corporate Responsibility Program, including the duty to comply with applicable laws and regulations, and reporting to designated Manager (or employer hotline) any suspected unethical, fraudulent, or unlawful acts or practices.
Participates in and encourages associates to participate in activities that benefit the community.
Performs other duties and responsibilities as may be assigned from time to time.
Adheres to the standards and policies of the Corporate Responsibility Program, including the duty to comply with applicable laws and regulations, and reporting to designated Manager (or employer hotline) any suspected unethical, fraudulent, or unlawful acts or practices.
Participates in and encourages associates to participate in activities that benefit the community
Performs other duties and responsibilities as may be assigned from time to time.
This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Employees may be required to perform other job-related duties as required by their supervisor, subject to reasonable accommodation.
REQUIRED
Bachelor’s degree in Business Administration, Healthcare Management, or closely related field10 years’ experience of hospital contracting or payer contracting2+ years’ experience in financial modeling and reimbursement technologiesPrevious the healthcare industry experience, including insurance, managed care, integrated delivery systems, and employer benefit plansPREFERRED
Master’s degree in Finance, Business Administration, Healthcare Management, Accounting, or a relatable fieldPrevious experience in healthcare finance and decision supportSkills
Strong analytical, verbal and written communication, and presentation skills
Proficiency in spreadsheet and database programs
Legal and contractual compliance
Building and maintaining effective working relationships, internally and externally
Meeting deadlines
Data mining from internal and external sources
Data analysis and interpretation
Critical thinking and analysis
Positivity and willing attitude
Effective organizational and change agility
Leading with influence
Prioritization and organization
Confidentiality
Detail orientation, especially in context of the big picture
Ability to work independently and collaboratively
Proficient in Microsoft Office and other common software programs common for completion of responsibilities
Many of our opportunities reward* your hard work with:Comprehensive, affordable medical, dental and vision plans
Prescription drug coverage
Flexible spending accounts
Life insurance w/AD&D
Employer contributions to retirement savings plan when eligible
Paid time off
Educational Assistance
And much more
*Benefits offerings vary according to employment status
All applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, sexual orientation, gender identity, age, genetic information, or protected veteran status, and will not be discriminated against on the basis of disability. If you'd like to view a copy of the affirmative action plan or policy statement for Mercy Health – Youngstown, Ohio or Bon Secours – Franklin, Virginia; Petersburg, Virginia; and Emporia, Virginia, which are Affirmative Action and Equal Opportunity Employers, please email recruitment@mercy.com. If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact The Talent Acquisition Team at recruitment@mercy.com