Payer Contract Manager Sr

MultiCare Health System

6d

About The Position

The Senior Payer Contract Manager is responsible for developing and implementing contracts with third party payers on behalf of MultiCare Health System and its affiliates. This role ensures MultiCare, and our affiliates have consistent and well-functioning relationships with payers over time, in alignment with MultiCare’s vision and strategic priorities. The Manager will lead negotiations with assigned payers to include payment terms based on multiple reimbursement models, including fee-for-service payment terms, value-based payment terms, and gain/risk sharing arrangements. The Manager serves as the lead managing the overall payer relationship, makes recommendations to Sr. Leadership on product participation, and will continually evaluate the payer relationship for opportunities to improve revenue, lower the cost of doing business, and to improve MultiCare’s access to patents. The Manager is accountable for negotiating contract language that aligns with all State and Federal laws and regulations, is consistent across payers, and does not expose MultiCare financial, legal, or operational risk to MultiCare or the payer.

Requirements

• Bachelors degree with a major in finance, Healthcare administration, or related field; or 10+ years’ experience in Payer Contracting for a Health System or Health Plan as degree equivalent
• Minimum seven (7) years of experience performing financial/medical data/payer mix analysis or contract negotiation in a healthcare environment, health system or health plan; acute care setting experience preferred
• Experience with medical and pricing terminology to include but not limited to DRG, RUG, APC, RVU, Conversion Factors

Nice To Haves

• Seeking candidates with a behavioral health background
• knowledge of Washington Medicaid
• experience in payer or provider contracting
• local to Washington State preferred

Responsibilities

• developing and implementing contracts with third party payers
• lead negotiations with assigned payers to include payment terms based on multiple reimbursement models, including fee-for-service payment terms, value-based payment terms, and gain/risk sharing arrangements
• managing the overall payer relationship
• makes recommendations to Sr. Leadership on product participation
• continually evaluate the payer relationship for opportunities to improve revenue, lower the cost of doing business, and to improve MultiCare’s access to patents
• negotiating contract language that aligns with all State and Federal laws and regulations

Benefits

• Competitive tuition assistance
• award-winning residencies
• fellowships and career development to invest in your future
• Generous PTO
• Code Lavender and Employee Assistance Programs to help you maintain balance and feel cared for at work and in life

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level