DE - Contracting and Payer Relations Executive Director

Job Description:

Bayhealth Medical Center is Central and Southern Delaware s healthcare leader with hospitals in Dover (Kent Campus) and Milford (Sussex Campus), a stand-alone ED in Smyrna and a hybrid ED/Urgent Care in Milton (Bayhealth TotalCare). Bayhealth Medical Center provides a wide range of healthcare services including cardiac surgery, neurosurgery, orthopedics and rehabilitation, pediatrics, level II neonatal ICU, radiology and women s services. We are COMMITED to provide excellent, compassionate care to our many patients, providing them with a comforting experience in their time of need and crisis. Bayhealth Medical Center is affiliated with the Penn Cancer Network and the University of Pennsylvania-Penn Orthopedics New Graduate Medical Education programs for physicians teaching institutions are centers that value growth, education and collaboration.
Forbes 2024 List of Best Place to work by State. Bayhealth Medical Center ranked in Delaware.
Our healthcare system has more than 4,500 employees.
Bayhealth Medical Center Kent Campus is 90 minutes from Philadelphia, Washington, DC and Baltimore. Our Sussex Campus is 30 minutes to the Delaware beaches and relaxation in the sand.
Bayhealth Medical Center offers competitive salary and a comprehensive benefits package including:
Paid Time Off and Paid Holidays
Matching 401(k)/403(b) Plans
Excellent Health, Dental, Vision, Disability and Life Insurance options
Bayhealth Medical Center is looking for a Contracting & Payer Relations Executive Director who is engaged in their profession, committed to providing the best service and believe in the mission of Bayhealth. We are looking for staff with Compassion, Accountability, Respect, Integrity, Teamwork.
Whether you are seeking work/life balance or the excitement of never knowing what is coming in the door next, we can help connect you to your future.
Location: Kent Campus Hospital
Status: Full Time 80 Hours
Shift: Days
SALARY STARTING: YEARLY
General Summary:
Reporting to the CFO, the Executive Director of Contracting & Payer Relations is responsible for all aspects of managed care, governmental, value-based and population health/clinical integration for Bayhealth Medical Center and Bayhealth Medical Group. The position is charged with developing and improving relationships with third-party payers. As a key member of the Revenue Cycle team, the senior director ensures reimbursement rates are as robust as possible and that third-party payers are abiding by the contract terms. The Executive Director works collaboratively with the other Revenue Cycle leaders and key stakeholders to make certain that everyone is aware of, and strives to correct, issues or disagreements arising with payers.
Responsibilities:
1. Negotiates agreements with third-party payers to achieve operating terms and reimbursement rates that will support Bayhealth s strategic goals.
2. Generates reports that describe the successes and opportunities in the revenue cycle.
3. Meets with leadership of Delaware based plans to discuss strategic plans and opportunities for improvement and collaboration.
4. Recommends managed care contracting strategy to CFO.
5. Serves as the primary source of communication and liaison with third-party payers.
6. Fosters effective collaboration between departments to ensure a consistent and integrated approach in daily operations to managed care requirements.
7. Collaborates with Denials Department to create effective appeals.
8. Conducts regularly scheduled meetings with third-party payers to improve payment processes and follow-up on claims due and other outstanding issues.
9. Represents Bayhealth in state-wide meetings and participates with regional associations.
10. Accountable for the overall success of Bayhealth s managed care strategy.
11. Maintains the EPIC contract management system.
12. Ensures that annual payment adjustments are accurate and complete.
13. Creates Price Transparency machine-readable files each year.
14. Serves on utilization review, level of care, and readmission committees.
15. Negotiates single-case agreements as required.
16. Provides input on charge master development and adjustments.
17. All other duties as assigned, within the scope and range of job responsibilities.
Required Education, Credential(s) and Experience:
Education: Master Degree Business Administration
Credential(s): None Required
Experience: Required: Minimum 10 years of contract negotiation with Managed Care Organizations
Preferred Education, Credential(s) and Experience:
Education: Master Degree Health Administration or Related field
Credential(s): Certification related to the position, if applicable.
Experience:

Position Urgency:
Normal

Shifts:
Days, Full Time

State License Details:
Upon Acceptance

Minimum Years of Experience:
10

Specialty Type:
Management

Sub Specialty:
All Management, Director of Business Office

Bilingual:
No

Holiday Coverage Required:
No