[Hiring] Manager - Payer Strategies @UHS

Role Description

Manager - Payer Strategies (Acute) - supporting 10 hospitals (9 in Texas, 1 in Oklahoma). This role is focused on the tactical execution, administration, and maintenance of hospital and physician managed care contracts and offers guidance on rate proposals and negotiation approaches.

• Manages the full contract negotiation cycle for assigned contracts, focusing on specific financial reimbursement terms, rates, and language.
• Coordinates the implementation of new or renegotiated contracts within the organization and ensures compliance with contract terms.
• Collaborates with internal stakeholders to monitor payment accuracy and contract performance.
• Serves as subject matter expert on contract specifics for the revenue cycle team and case management teams.
• Acts as a primary point of contact for routine payer-related issues, disputes, and information sharing.
• Works closely with finance and data analytics teams to provide support for negotiations and monitor contract performance metrics.
• Develops strategies for contract relationships and negotiations.
• Responds to market opportunities and monitors significant market changes to protect and enhance market share.
• Analyzes the significance and value of potential contracts.
• Determines the cost of care based on care delivery and contract structure.
• Projects contract performance based on modeling of actual and representative samples.
• Develops contract language to protect UHS best interest and satisfy strategic contracting objectives.
• Reviews and revises language templates and counter proposal language for Health Plans.
• Ensures that terms meet the financial and operational needs of UHS.
• Develops structures that are appropriate to the institution, including a full range of reimbursement structures.
• Considers cost of care or performance targets in relation to the size and scope of the contract.
• Develops and analyzes rates for proposals or counter proposals.
• Serves as a liaison and knowledge resource to Revenue Cycle and other Operational Departments regarding ongoing contract compliance.
• Analyzes and monitors contract requirements, special provisions, terms, and conditions to ensure compliance with appropriate laws, regulations, and UHS policies.
• Engages in preparation and planning of annual renegotiations.
• Reviews and develops contract language, maintains historical records of payor/contract information.
• Participates in negotiation strategy and offers suggestions for changing future contracts.
• Establishes and implements a consistent schedule of Joint Operations Committee (JOC) meetings with key payors.
• Addresses contract performance, including revenue cycle, utilization management, and other operational issues.
• Provides ongoing analysis and reporting on existing contracts for compliance, performance reviews, and long-range planning.
• Studies historical utilization and trends in revenues through financial data.
• Identifies issues with the operation of contracts and updates the Regional Director of Managed Care and Payer Strategies on unexpected changes.
• Produces operational statistical reports to provide contracting team with tools for strategy and decision making.
• Monitors contract payments and reviews them for accuracy of package rates and volume of services by payor.
• Addresses operational issues with payers by proactively identifying issues and soliciting information and feedback.
• Prepares Payor Scorecards for Revenue Cycle for use during contract negotiations.
• Develops tools and procedures for use by various operational departments.
• Manages contract software and dataset tools that populate contract rate grids.
• Ensures final documents include all necessary UHS Regional terms and conditions.
• Manages specific projects/committees or represents specific entities as needed.
• Mentors the Contracting Department staff and assists with training as needed.
• Attends team meetings and participates in discussions and strategic initiatives.
• Performs other duties as assigned/required.

Qualifications

• Bachelor’s degree in finance, Business/Economics, Healthcare Administration, or a related field. Master’s Degree preferred.
• A minimum of five years of experience in a healthcare organization or within the health insurance industry.
• Experience in a large healthcare organization or academic medical center is preferred.
• Proven track record in contract negotiations.

Requirements

• Advanced computer operation competency with spreadsheet, word processing, calendar, and email applications.
• Practiced in managed care database development, management, and navigation.
• Negotiation expertise along with acumen to achieve stretch goals in difficult circumstances.
• Disciplined in handling challenging communication professionally.
• Ability to work across organizations and represent physicians and hospital interests.
• Excellent organization, time management, and problem-solving skills.
• Adept at tracking, editing, and monitoring complex contracts.
• Effective written and verbal communication skills.

Travel

• Up to 5% US or internationally travel.