This position is responsible for the management and oversight of payer strategy and contracting at Gillette Children’s. This position is also responsible for pricing strategy and payer reimbursement analysis. Reporting to the Vice President, Revenue Cycle- this position will collaborate with the VP, RCM and CFO to develop and execute on revenue strategy for the organization. This position does not have direct reports. 

This is primarily a remote opportunity; however, the selected candidate must reside in Minnesota or Wisconsin and have the ability to work onsite in St. Paul, MN as needed (at minimum, bimonthly). 

Compensation & Benefits 

The annual salary range for this opportunity is $119,204/annually to $178,817/annually, with a median salary of $149,011/annually. Pay is dependent on several factors including relevant work experience and internal equity. Salary is just one component of the compensation package for employees. Gillette supports career progression and offers a competitive benefits package, including a retirement saving match, tuition and certification reimbursement, paid time off, and health and wellness benefits for .5 FTE and above.

Primary Job Responsibilities 

• Commercial Contract Administration
  • Maintains contract records of all third-party payer contracts.
  • Provides direct support to CFO in negotiations with third party payers
  • Keeps contract information with payers current. Informs VP, Revenue Cycle and CFO of upcoming expiration and renewals of third party payer and contracts.
  • Evaluate and monitor contract performance to determine necessity for amendments, updates, or extensions or contracts and compliance to contractual obligations

• Government Payer Strategy
  • Stays current on all statutes and rules affecting Medicare and Medicaid reimbursement and communicates changes in those statutes and rules to the rest of the organization.
  • Monitors Medicare and Medicaid reimbursements and work with Revenue Cycle and Patient Access leadership to take corrective action as needed
  • Develops and implements policies and procedures that maximize Medicare and Medicaid base rate and DSH reimbursement.
  • Develops and maintains appropriate relationships with Minnesota DHS, the Minnesota Hospital Association and the Fiscal Intermediary

• Pricing Strategy
  • Supports the VP, Revenue Cycle and CFO in developing and implementing hospital pricing.
  • Performs comparisons of Gillette charges to general market and competitors, making timely recommendations to senior management for corrective action.
  • Analyzes alternate payment methodologies
  • Partner with VP, Revenue Cycle and Director, Financial Planning & Analysis to help model the revenue impact of various initiatives

• Denials Management and Reimbursement Analysis
  • Lead the analysis of all payer reimbursement
  • Work with VP, Revenue Cycle to manage contracting software to monitor for underpayments
  • Work with payers to proactively reduce denial exposure.

• Vision Communication
  • Able to articulate a clear and compelling image of what the organization must become. Uses a wide diversity of methods to communicate the vision and works actively to ensure that the message is not only understood but also translated into the specific behaviors that will make it a reality. Provides staff with a definite sense of direction and purpose. Serves as a personal model of what is needed.

• Strategic Thinking
  • Identifies potential options and constraints. Critically evaluates information and seeks to achieve outcomes which are in the best interest of Gillette. Translates strategy into action.

• Financial Acumen
  • Has a solid understanding of key business fundamentals. Demonstrates the ability to lead cost efficient initiatives without sacrificing quality, patient care, or customer service. Knows how to manage, deploy, and leverage resources.

• Focus on Results
  • • Takes action to meet objectives and follows through to ensure successful completion. Does not get distracted before a project is completed. Establishes high standards of excellence for staff. Keeps people focused on the highest priority goals and objectives. Is skillful at getting people to stretch for goals that go beyond what they originally thought possible. Can be counted on to follow through on commitments.

• Relationship Building
  • • Builds effective relationships across the organization to accomplish the work and focus on patients/customers more effectively. Balances “getting results” with a concern for others’ needs. Works to achieve optimal joining of ideas, projects, services, and programs. Shows respect and appreciation for the ideas and contributions of others. Is trusted by all members of the work group.

Qualifications

Required

• Bachelor’s degree in finance, business, healthcare management, or related degree
• Minimum of five years’ experience in healthcare, finance, or related field
• Advanced knowledge of the hospital-based operations related to the revenue cycle

Knowledge, Skills and Abilities

• Proven ability to work independently, set priorities, and mange deadlines
• Ability to problem solve and initiate improvement actions
• Proven ability to work in a matrix structure with multiple departments and managers
• Ability to project operational and financial impact of contract terms

Preferred

• MBA or MHA degree
• Advanced understanding of the US commercial and government healthcare and reimbursement environment
• Advanced understanding of Compliance Guidelines
• Advanced knowledge of healthcare reimbursement methodologies

Gillette Children’s is committed to recruiting and retaining a diverse team, as we know that the diverse experiences of our employees make Gillette a stronger and better organization. We are committed to creating an equitable and inclusive environment where all patients, families and staff are welcomed and valued. We believe diverse perspectives and identities foster excellence, improve patient care and are essential for Gillette to fulfill its mission. Our team members collaborate to help patients of all backgrounds and abilities reach their full potential.

Gillette Children's is an equal opportunity employer and will not discriminate against any employee or applicant for employment because of an individual's race, color, creed, sex, religion, national origin, age, disability, marital status, familial status, genetic information, status with regard to public assistance, sexual orientation or gender identity, military status or any other class protected by federal, state or local laws.

Gillette Children’s is a global beacon of care for patients with brain, bone and movement conditions that start in childhood. Our research, treatment and supportive technologies enable every child to lead a full life defined by their dreams, not their diagnoses.

To learn more about working at Gillette Children's, please visit https://www.gillettechildrens.org/careers.

Gillette Children's participates in the U.S. Department of Homeland Security (DHS) E-Verify program which is an internet-based employment eligibility verification system operated by the U.S. Citizenship and Immigration Services. If E-Verify cannot confirm that you are authorized to work, Gillette will give you written instructions and an opportunity to contact DHS or the Social Security Administration (SSA) to resolve the issue before Gillette takes any further action. Please visit https://www.e-verify.gov/ for further details regarding e-verify.