Senior Director, Provider Contracting - Denver Health Medical Plan (* Onsite *)

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Department

Job Summary

Under the general supervision of the CFO, the Senior Director of Provider Contracting is responsible for developing and implementing new and established contracts for facility and professional agreements with providers on behalf of Denver Health Medical Plan, including new programs and services. This role will lead negotiations with providers to include payment terms based on multiple reimbursement models, including fee-for-service payment terms, valued based payments, and gain/risk sharing arrangements. The Senior Director will be accountable for negotiating contract language that aligns with all State and Federal laws/regulations and organizational policies. This position will be responsible for development of practices consistent with the mission and vision of Denver Health Medical Plan.

Essential Functions:

• Oversee organizational contract development and management activities and enforce organizational principles of integrity and compliance (15%)
• Develop standards for contracts, including payment terms, general language and provisions based on strategy discussions, senior management input and organizational needs (15%)
• Evaluate rate proposals, changes to reimbursement methodologies and conduct related analyses to ensure continued financial viability of the contract (10%)
• Ensure contracts and proposals are properly entered into organizational databases to measure, track and monitor utilization and financial performance (10%)
• Negotiate single case agreements as needed (5%)
• Serve as primary organizational contact during provider contract negotiations (10%)
• Identifies network needs and manages the recruitment and contracting process for new providers and institutions (5%)
• Ensure prompt resolution of all escalated concerns or issues from the Plan's provider network (5%)
• Participate in JOC meetings with providers to address contractual payment issues and trends (5%)
• Validate the proper uploading, adjudication, and pricing of claims (5%)
• Maintain knowledge and understanding of healthcare industry trends, standards, and current events relative to provider contracting, network administration and market (5%)
• Carry out supervisory responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems (5%)
• Special projects/ other duties as assigned by the CFO (5%)

Education:

• Bachelor's Degree Degree Concentration in Finance, Accounting, Business, Management, Healthcare Administration related field Required

• 10+ years Contract Management demonstrated experience required; provider contracting experience preferred required
• 4-6 years manager experience required, preferably in healthcare required

Licenses:
Knowledge, Skills and Abilities:

• Strong knowledge of Medicaid, Commercial ACA, Medicare, and CHP+ lines of business is required
• Knowledge of CPT, ICD-9 and 10, DRG, HCPCS, RBRVS, bundled payments, risk-sharing, and provider capitation is essential
• Extensive knowledge and experience with Medicare/Medicaid regulations
• Excellent negotiating skills and proficiency in utilizing and interpreting financial models and analysis
• Requires high attention to detail, analytical and critical thinking, management skills, organization, prioritization and problem resolution
• Excellent verbal and written communication, leadership, delegation, collaboration and interpersonal skills
• Ability to be resourceful, customer-service oriented and independently problem solve is required

Shift

Work Type

Salary

Benefits

• Outstanding benefits including up to 27 paid days off per year, immediate retirement plan employer contribution up to 9.5%, and generous medical plans

• Free RTD EcoPass (public transportation)

• On-site employee fitness center and wellness classes

• Childcare discount programs & exclusive perks on large brands, travel, and more

• Tuition reimbursement & assistance

• Education & development opportunities including career pathways and coaching

• Professional clinical advancement program & shared governance

• Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program

• National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer

Our Values

• Respect

• Belonging

• Accountability

• Transparency

All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made.

Denver Health is an integrated, high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center, a 555-bed acute care medical center, Denver's 911 emergency medical response system, 10 family health centers, 19 school-based health centers, Rocky Mountain Poison & Drug Safety, a Public Health Institute, an HMO and The Denver Health Foundation.

As Colorado's primary, and essential, safety-net institution, Denver Health is a mission-driven organization that has provided billions in uncompensated care for the uninsured. Denver Health is viewed as an Anchor Institution for the community, focusing on hiring and purchasing locally as applicable, serving as a pillar for community needs, and caring for more than 185,000 individuals and 67,000 children a year.

Located near downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.

Denver Health is an equal opportunity employer (EOE). We value the unique ideas, talents and contributions reflective of the needs of our community.

Applicants will be considered until the position is filled.