Senior Director, Payor Strategy & Contracting

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HSS is consistently among the top-ranked hospitals for orthopedics and rheumatology by U.S. News & World Report. As a recipient of the Magnet Award for Nursing Excellence, HSS was the first hospital in New York City to receive the distinguished designation. Whether you are early in your career or an expert in your field, you will find HSS an innovative, supportive and inclusive environment.

Working with colleagues who love what they do and are deeply committed to our Mission, you too can be part of our transformation across the enterprise.

Senior Director, Payor Strategy & Contracting

Full-Time

Overview:

Reporting directly to the Assistant Vice President, Payor Strategy and Contracting, the Senior Director Payor Strategy and Contracting will be primarily responsible for the negotiation, implementation and oversight of payor contracts and relationships. The Senior Director will work closely with the analytics team to model all contract proposals including fee-for-service and value-based arrangements (i.e., shared savings, bundles, etc.). They will work closely with the contract operations team to troubleshoot contract operational issues and assist where necessary to bring them to resolution using their understanding of the underlying contracts as well as by leveraging their payor relationships.

RESPONSIBILITIES:

• Meets with senior leadership to ascertain and develop strategic payor contracting goals.
• Negotiates contracts ensuring financial and strategic goals are translated into contractual language accordingly.
• Analyzes payor contract proposals in conjunction with the analytics team to ensure contracts meet financial goals.
• Works closely with the legal team to review and edit contracts as appropriate.
• Ensures internal stakeholders are aware of contract terms, reimbursement rates, and payor policies and that contract terms are appropriately communicated/translated into front and back-end processes.
• Works closely with the revenue cycle teams to ensure contracts are loaded appropriately into billing and decision support systems.
• Works closely with the contract operations team, UM/clinical denials team, and revenue cycle teams to identify trends and opportunities in outstanding accounts receivable.
• Escalates issues as necessary to payor contacts for resolution. In conjunction with contract operations, recommends escalation through senior management as appropriate.
• Identifies trends/patterned issues to aid in contract renegotiations.
• Assesses contract administrative terms and advises leadership accordingly on measures of contract performance.
• Maintains up to date knowledge on the healthcare market, specifically in regard to payor policies and reimbursement trends.
• Possesses strong leadership skills and demonstrates capability to inspire staff to pursue excellence in goals and productivity; capable of coaching and improving staff in need of professional development. Places high priority on overall team performance.
• Additional responsibilities as required to accomplish departmental goals.

EXPERIENCE, COMPETENCIES, AND PERSONAL CHARACTERISTICS: 

• Experience (10+ years) in payor or provider contracting, provider network oversight and/or revenue cycle management. Major teaching/surgical hospital experience or health plan experience is highly desirable.
• Experience managing and leading a professional team.
• Experience dealing with payors, patient financial services professionals, providers, and their billing staff.
• Possesses key payor contacts and knowledge of payor contracting.
• Is detail oriented.
• Knowledge of the healthcare industry and payor reimbursement methodologies (both hospital and physician).
• Ability to work independently and collaboratively to solve complex problems.
• The ability to influence and motivate others, as well as work collaboratively within a multi-stakeholder environment is required.
• Excellent verbal and written communication skills.
• Excellent organizational and multi-tasking skills.
• Is professional when dealing with stakeholders. Uses good judgement and takes a thoughtful approach to resolving and communicating issues.

EDUCATION:

• Bachelor’s degree in health or business administration, economics or related subject is required. Master’s preferred.