Manager of Payor Contracting | South Portland, ME

CORE RESPONSIBILITIES: 

Contract Negotiations & Support of Overall Strategy 

• Negotiate and contract to optimize reimbursement structures and rates with payor partners, including the facilitation of the approval and signature process. 
• Negotiate language and terms and conditions across all payor contracts, primarily value-based 
• Work directly from guidance of Director of Payor Contracting to support a work plan/strategy 
• Work to support system strategic initiatives, as directed by the Director of Payor Contracting 
• Develop guidelines for best practice items and key contractual acceptable language to support negotiations with a consistent approach where possible 
• Amend existing agreements to find opportunities for coverage of new services or to enhance current contract terms in terms of new language or operational needs  
• Leverage internal BI/RCM data to assure negotiated rates and rate requests maintain our competitive position 
• Stay informed on market trends and healthcare industry shifts to help inform overall payor strategy and successful negotiations 

Outcomes Management & Operational Support 

• Recommend necessary strategies to leadership based on contract performance 
• Work closely with RCM on operational issues related to Payor Contracting - includes attendance at Payor Ops and Joint Operating Committee (JOC) meetings and support to RCM leadership to help monitor financial performance of assigned payor contracts versus expectations  
• Partner with teams directly responsible for validation of payments and/or policy monitoring 
• Identify and develop strategies to mitigate risks and sources of exposure in payor contracts 
• Proactively work with BI and other data teams to refine the reporting of contract performance, analysis, and modeling tools 
• Prepare relevant recommendations and reports for committees and boards, as required 

Stakeholder Support & Engagement 

• Establish and maintain relationships with payors contacts and help facilitate overall relations 
• Provide education on new agreements - via written communication or presentations - that may impact stakeholders.  
• Address leadership data needs resulting from new/modified agreements 
• Work with other internal partners on supporting/leading select system strategies where Contracting can drive specific change or help develop new processes 
• Contribute to communications and education regarding Payor Contracting utilizing tools such as the electronic newsletter, educational sessions, or other appropriate forums as needed 
• Interact with providers to identify payor trends requiring action or escalation 
• Continue to grow knowledge of market trends via conferences, continuing education, etc. 
• Maintains strict confidentiality in alignment with HIPAA (Health Insurance Portability and Accountability) guidelines and InterMed policies.  
• Perform other duties to support the mission, vision and values of InterMed.   

MISSION AND VALUES:  

• Follows InterMed’s mission to provide patient-centered primary care, putting the patient first to deliver high quality, high value care.  
• Provide the highest quality care to our patients with a level of service that exceeds their expectations.  
• Maintain a positive attitude and always treat our patients and each other with dignity and respect.  
• Insist on honesty and integrity from each other and our business partners.  
• Make teamwork a core component of our relationships between physicians, staff, and patients.  
• Embrace change to better serve our patients.  
• Use business practices that feature individual accountability and group responsibility to ensure delivery of high value healthcare.  
• Have fun as we carry out our mission to serve.  

KNOWLEDGE, SKILLS, AND ABILITIES: 

Education: 

• Bachelor's degree required. Preferred areas of study include Healthcare Administration, Business, Finance, or another related field. 

Experience:

• Minimum 3 years of experience in a similar or related role such as managed care/ACO contracting, provider/payor relations, project management, physician organization, hospital organization or health plan. 
• Experience in value-based healthcare strongly preferred 
• Demonstrated experience in negotiating and managing complex payor contracts 
• Proficiency in Microsoft Office suite 
• Strong organizational and time management skills to help prioritize tasks and meet deadlines  
• The ability to build strong relationships with internal/external stakeholders 
• Strong analytical and problem-solving skills 
• The ability to interpret and present operational and financial impacts related to Payor contracts 
• Strong interpersonal, communication (written/verbal) and presentation skills 
• Awareness of relevant healthcare industry trends