Cincinnati Children’s Hospital is conducting a search for a Director of Payor Relations & Contracting responsible for the planning, development, direction and maintenance of outside third party payor and provider contracting relationships. The Director will exercise general day- to-day supervision over Payor Relations department staff engaged in contract negotiations with third party payors. Lead negotiator for major health plans and other third party payors’ contract negotiations.
Additional responsibilities include:
Partners with Revenue Cycle Management and other CCHMC management, to negotiate favorable contract terms for professional, hospital, ancillary, and other services for CCHMC and the PHO. Assist in developing and implementing annual contracting plan through individual contract negotiations and directing efforts of contract negotiation staff for CCHMC and PHO.
Reviews and analyzes all fee schedules for appropriateness and compliance. Recommends annual fee changes and pricing policies. Develop analytical reports to demonstrate financial impact of proposed arrangements for physician, hospital and PHO contracts.
Monitors and continually evaluates third party payor contracts in conjunction with staff, AVP, and VP- Revenue Cycle. Track, monitor, evaluate, and distribute changes to medical/reimbursement/prior authorization policies and requirements that are distributed by third party payors.
Develops and maintains appropriate working relationships with the decision-makers and operating/clinical departments of various third party payor products and insurance companies.
Ideal candidates will have a Bachelor’s degree in Healthcare Administration, Business, Finance, or related discipline plus minimum ten years of related experience, including 2-3 years of proven financial and third party payer contracting experience. Supervisory experience in a complex organization. Experience with PHO, professional, ancillary, and hospital negotiations in an academic medical center required. Strong Analytical skills to analyze fee schedules and other reimbursement methodologies compared to our billed charges and/or costs.
Internal Number: 99203
About Cincinnati Children's Hospital Medical Center
Cincinnati Children’s Hospital, a nonprofit academic medical center established in 1883, and is one of the oldest and most distinguished pediatric hospitals in the United States. We offer comprehensive clinical services, from treatments for rare and complex conditions to well-child care. In the 2017-18 U.S. News & World Report survey of best children’s hospitals, Cincinnati Children’s ranked No. 3 among all Honor Roll hospitals.