Payor Strategy and Contracting Director

Martin's Point Health Care | Portland, ME, United States

Posted Date 5/27/2021
Description

Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day. Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015.

The Payor Strategy and Contracting Director is responsible for the execution of our Delivery System (DS) reimbursement strategy including planning the DS shift from fee-for-service to value-based reimbursement. Payment transformation will be central to this role. It will require careful coordination with all DS leaders to ensure that our health plan contracts reflect our evolving care transformation. This will include alignment with our finance strategy, our quality improvement efforts, as well as our practice operations so that we implement strategies that align with our contract terms. The Director will also play a supporting role in our efforts to collaborate with other providers (hospitals and specialists in our local markets) in support of the delivery of high-value care to our patients. The Director will also work closely with our Health Plan leaders as we build systems to support the care of our Medallion members.

Key Outcomes:

  • Develop and implement new payment arrangements to support care model transformation in the DS in alignment with Martin’s Point’s strategic goals.
  • Serve as DS leader for government payment changes (both Medicare and Medicaid) and develop strategy to support high-level performance in these payment models.
  • Coordinate with Clinical Integration team to stay current on DS quality improvement activities. This will include maximizing alignment of contract incentives with existing DS priorities and consistency in quality metrics in our health plan contracts.
  • Support the tracking, evaluation, and reporting of DS contract performance, including quality, experience, and total cost of care.
  • Lead DS Joint Operating Committee meetings with each health plan.
  • Collaborate with other DS Directors to ensure appropriate provider/care team education and understanding of key contract initiatives.
  • In conjunction with DS and enterprise data/analytics team, regularly review and monitor contract performance against cost of care and quality targets.
  • Regularly consult with Revenue Cycle leadership to ensure health plan payments are completed according to negotiated contract terms and that all fee schedules are current.
  • Effectively develop, report, and communicate operational metrics to track the department performance against prescribed goals and regulatory requirements.
  • Partner with Finance and Legal Departments to monitor contract terms and stay current on relevant trends in provider/payor contract terms.
  • Work closely with Health Plan Network Management Department to ensure Martin’s Point’s contracting strategies are consistent in all departments and current with industry best practices.

Education/Experience:

  • Bachelor’s degree in relevant field; Master’s degree preferred
  • 10+ years of experience in healthcare, preferably in Provider Contracting or Physician Practice Management
  • Experience in contract negotiations and knowledge of various reimbursement methodologies
  • Experience in data analysis, reports, and financial modeling
  • Experience in primary care practices preferred

Required License(s) and/or Certification(s):

  • None

Skills/Knowledge/Competencies (Behaviors):

  • Demonstrates an understanding of and alignment with Martin’s Point Values
  • Strong provider contracting knowledge including alternative payment models
  • Familiarity with primary care practice operations and how reimbursement models impact the way care is delivered
  • Demonstrated ability to lead, manage and develop strong, collaborative internal and external relationships
  • Excellent communication skills (oral and written)
  • Excellent negotiation skills and expertise managing health plan and employer relationships
  • Ability to translate strategic objectives into specific achievable actions and plans
  • Ability to plan, organize, and prioritize multiple activities
  • Ability to solve complex problems, evaluate alternatives, and make sound decisions
  • Ability to make presentations and reports to internal and external audiences
  • Detail oriented with continuous attention to compliance/contractual requirements
  • Demonstrated ability to lead change (internally and externally) and produce measurable results within a specified time period

We are an equal opportunity/affirmative action employer.

Do you have a question about careers at Martin’s Point Health Care? Contact us at: jobinquiries@martinspoint.org

Geographic Region
Greater Portland/Casco Bay
Industry
Healthcare | Management

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