Manager, Payer Contracting - St. Luke's Health Partners
US-ID-Boise
careers
Req #: 100970
Type: Full-Time
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Overview: The Manager, Payer Contracting is a key role for St. Luke's Health Partners accountable for the payer contract portfolio, to include oversight of the timely drafting, negotiation, and execution of payer agreements, ensuring contracts are completed within required timeframes and stored appropriately for easy access. St. Luke's Health Partners is a wholly owned subsidiary of St. Luke's Health System, and a financially and clinically integrated network of providers improving the health outcomes of the population and lowering the cost of care. We offer a dynamic, collaborative work environment that values innovation, cross-functional teamwork, and work-life balance. What You Can Expect: * Establishes and maintains network professional and facility outbound interim payment schedules, and/or prospective capitation payment schedules. * Ensures payers adhere to such payment schedules and performs audits as necessary. * Collaborates with internal stakeholders, including legal, finance, and network operations, to validate contract terms, mitigate risks, and ensure agreements reflect negotiated terms. * Tracks and monitors agreement status from initial draft through execution, proactively addressing delays and facilitating issue resolution to maintain efficiency. * Facilitates knowledge sharing and professional development for the Reimbursement Analyst, ensuring they stay current on industry trends, reimbursement policies, and data analysis best practices. * Works closely with Health Partners Administrator, President and the broader Provider Network team to develop and communicate strategy, tactics, and payer relationship management. Minimum Requirements: * Bachelor's Degree * 5 year's relevant experience (related to healthcare payer contracting) Responsibilities: Manager Payer Contracting Oversee the timely drafting, negotiation, and execution of payer agreements, ensuring contracts are completed within required timeframes and stored appropriately for easy access. Establishes and maintains network professional and facility outbound interim payment schedules, and/or prospective capitation payment schedules. Ensures payers adhere to such payment schedules and performs audits as necessary. Collaborate with internal stakeholders, including legal, finance, and network operations, to validate contract terms, mitigate risks, and ensure agreements reflect negotiated terms. Track and monitor agreement status from initial draft through execution, proactively addressing delays and facilitating issue resolution to maintain efficiency. Facilitate knowledge sharing and professional development for the Reimbursement Analyst, ensuring they stay current on industry trends, reimbursement policies, and data analysis best practices. Work closely with the broader Provider Network team to develop and communicate strategy, tactics, and payer relationship management. Assesses competitor capabilities, payer landscape, and regulatory changes within various lines of business. Leads initiatives that further improves the performance of value-based arrangements Provides leadership to the Reimbursement Analyst and oversees payer contract compliance by ensuring that payers comply with contract terms. Participates in committees with payer partners, associated governance structures, and ongoing activities in accordance with contractual agreements. Develops thorough knowledge of system capabilities and resources related to analytics and other supporting systems. Maintains contracts and documentation within contract management system. Ensures standardization and/or consistency to ensure compliance with objectives and/or regulatory requirements. Coordinates efforts regarding standardization of business processes. Communicate complex contractual and financial information clearly and persuasively to internal stakeholders, including executives, legal teams, and network providers. Ensure alignment with executive leadership by presenting key contracting considerations, risks, and recommendations for approval. Provides leadership, guidance, counseling, and continuing education to staff. Selects, develops, coaches, mentors, and assesses performance of staff. Works with staff to promote resolution of conflict and counsels staff when standards are not met.
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