Director of Payer Contracting
It's the people that make a difference. Are you ready to make your impact?In 2023, OrthoIllinois and Midwest Orthopaedics at RUSH became divisions under a new entity called OrthoMidwest. We are two of the largest independent orthopedic practices in Illinois with locations in western and southern suburbs expanding across southern Wisconsin, Chicago, and northwest Indiana. Each entity is determined to deliver the highest level of dedication, innovation, and quality patient care.Primary Duties and
Responsibilities:
Responsible for the development, coordination, and analysis of payer contracts including commercial, work comp, and government payers. Responsible for overall strategy and execution of alternative payment model reimbursement methods. Including but not limited to Clinically Integrated Networks, ACOs, bundles, and capitation. Proactively negotiates reimbursement terms and language of payer contracts. Responsible for identifying ongoing managed care opportunities including bundled payment arrangements in the marketplace. Collaborates with OrthoComplete Business Development Managers regarding the employer direct contracting strategy. Responsible for setting group practice and ambulatory surgery center chargemaster methodology. Validates consistent chargemasters across divisions. Manages the planning process for contract renewals and negotiations including data analysis to substantiate contract proposals and counter proposals. Monitors and analyzes performance of third party payer agreements (including commercial, work comp, and government) for profitability, volume, strategic initiatives, and payer compliance issues. Collaborates with divisional Business Office staff and acts as a point of contact for resolution when payer issues arise related to provider enrollment. Responsible for management of a third party payer enrollment team in collaboration with divisional credentialing departments. Leadership:
Leads team to success by defining clear expectations, utilizing individual and shared strengths, while providing feedback for improvement and recognizing success; holds team accountable, and redirects group efforts to effectively meet organizational needs. Strategic Agility:
Ability to continuously adjust and adapt, to achieve a competitive advantage Business Acumen:
Ability to plan through strategic thinking; an understanding of all areas of a business' operations and how they are interconnected as well as the market landscape and competition; recognition of the financial elements of the business; and making decisions to maneuver a business through appropriate strategy Collaboration:
Demonstrates cooperation and teamwork working towards solutions that generally benefits all involved parties. Communication:
Actively listens, interprets verbal and nonverbal cues, and seeks to understand; presents information clearly both verbally and written with the goal to inform and care for patients; able to adjust presentation as needed for audience Decision Making:
Collects and reviews relevant data before acting balancing risk and rewards of options, encourages input from other subject matter experts, able to adjust opinions and recommendations based on new information, and objectively evaluates decisions after they have been made Organizational Culture:
All OrthoMidwest employees focus on service by putting the mission, vision, and value statements into practice and using the guiding principles of Compassion, Respect, Trust, Integrity, Innovation, Education, Fiscal Responsibility, Practice Independence, Accountability, and Empowerment to direct their interactions and decision making. Employees promote and model the service standards to create lasting impressions, extraordinary moments, exceptional on-stage experiences, and meaningful and compassionate connectionsEducation and Experience Requirements:
Master's degree in Finance, Accounting, Healthcare or related field from an accredited college or university A minimum of five years of experience in a similar position and/or performing similar tasks Prior experience working for local or national health insurance companies, preferred A minimum of four years of experience managing people Expert working knowledge of Microsoft and Google suites Environmental/Working Conditions:
Working environment is in an office/clinic setting. Occasional work hours outside of normal business hours, including evening and weekends.Physical/Mental Demands Sit for extended periods of time. Requires lifting, carrying and/or moving objects in a manner consistent with most office environments (generally, no more than 10 pounds on a frequent basis and 20 pounds on an occasional basis). Finger dexterity for typing on a keyboard and using a mouse for extended periods of time. Vision (e.g., depth perception, color vision, strong vision up close); hearing (e.g., high pitch sounds, soft or distant sounds). This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve. Our employees make the difference in our patients' lives, and we value their contributions. OrthoMidwest offers a comprehensive compensation and benefits package and an opportunity to grow and develop your career with an industry leader. Come see what we're all about. Equal Opportunity Employer. #J-18808-Ljbffr Recommended Skills Agility Balanced Budgeting Business Development Commercial Awareness Credentialing Data Analysis Apply to this job. Think you're the perfect candidate? Apply on company site $(document).ready( function() $(#ads-desktop-placeholder).html(
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n Estimated Salary: $20 to $28 per hour based on qualifications.
Responsibilities:
Responsible for the development, coordination, and analysis of payer contracts including commercial, work comp, and government payers. Responsible for overall strategy and execution of alternative payment model reimbursement methods. Including but not limited to Clinically Integrated Networks, ACOs, bundles, and capitation. Proactively negotiates reimbursement terms and language of payer contracts. Responsible for identifying ongoing managed care opportunities including bundled payment arrangements in the marketplace. Collaborates with OrthoComplete Business Development Managers regarding the employer direct contracting strategy. Responsible for setting group practice and ambulatory surgery center chargemaster methodology. Validates consistent chargemasters across divisions. Manages the planning process for contract renewals and negotiations including data analysis to substantiate contract proposals and counter proposals. Monitors and analyzes performance of third party payer agreements (including commercial, work comp, and government) for profitability, volume, strategic initiatives, and payer compliance issues. Collaborates with divisional Business Office staff and acts as a point of contact for resolution when payer issues arise related to provider enrollment. Responsible for management of a third party payer enrollment team in collaboration with divisional credentialing departments. Leadership:
Leads team to success by defining clear expectations, utilizing individual and shared strengths, while providing feedback for improvement and recognizing success; holds team accountable, and redirects group efforts to effectively meet organizational needs. Strategic Agility:
Ability to continuously adjust and adapt, to achieve a competitive advantage Business Acumen:
Ability to plan through strategic thinking; an understanding of all areas of a business' operations and how they are interconnected as well as the market landscape and competition; recognition of the financial elements of the business; and making decisions to maneuver a business through appropriate strategy Collaboration:
Demonstrates cooperation and teamwork working towards solutions that generally benefits all involved parties. Communication:
Actively listens, interprets verbal and nonverbal cues, and seeks to understand; presents information clearly both verbally and written with the goal to inform and care for patients; able to adjust presentation as needed for audience Decision Making:
Collects and reviews relevant data before acting balancing risk and rewards of options, encourages input from other subject matter experts, able to adjust opinions and recommendations based on new information, and objectively evaluates decisions after they have been made Organizational Culture:
All OrthoMidwest employees focus on service by putting the mission, vision, and value statements into practice and using the guiding principles of Compassion, Respect, Trust, Integrity, Innovation, Education, Fiscal Responsibility, Practice Independence, Accountability, and Empowerment to direct their interactions and decision making. Employees promote and model the service standards to create lasting impressions, extraordinary moments, exceptional on-stage experiences, and meaningful and compassionate connectionsEducation and Experience Requirements:
Master's degree in Finance, Accounting, Healthcare or related field from an accredited college or university A minimum of five years of experience in a similar position and/or performing similar tasks Prior experience working for local or national health insurance companies, preferred A minimum of four years of experience managing people Expert working knowledge of Microsoft and Google suites Environmental/Working Conditions:
Working environment is in an office/clinic setting. Occasional work hours outside of normal business hours, including evening and weekends.Physical/Mental Demands Sit for extended periods of time. Requires lifting, carrying and/or moving objects in a manner consistent with most office environments (generally, no more than 10 pounds on a frequent basis and 20 pounds on an occasional basis). Finger dexterity for typing on a keyboard and using a mouse for extended periods of time. Vision (e.g., depth perception, color vision, strong vision up close); hearing (e.g., high pitch sounds, soft or distant sounds). This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve. Our employees make the difference in our patients' lives, and we value their contributions. OrthoMidwest offers a comprehensive compensation and benefits package and an opportunity to grow and develop your career with an industry leader. Come see what we're all about. Equal Opportunity Employer. #J-18808-Ljbffr Recommended Skills Agility Balanced Budgeting Business Development Commercial Awareness Credentialing Data Analysis Apply to this job. Think you're the perfect candidate? Apply on company site $(document).ready( function() $(#ads-desktop-placeholder).html(
n
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n Estimated Salary: $20 to $28 per hour based on qualifications.
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