JOB SUMMARY

Dir Contracting and Operations is responsible for planning, developing, and implementing new and existing managed care contracts for Baylor Scott and White Health (BSWH), which may include contract development, negotiation, interpretation, and compliance. Monitors financial and operational performance of existing managed care contracts. Negotiates and administers contracts, contract rates, and contract terms with managed care payers. Directs and manages contract drafting, contract negotiations, and contract maintenance activities. Serves as strategic point of contact with managed care payers and consumers impacted by the operational aspects of managed care contracts. Ensures managed care organizations are compliant with the terms of the managed care contracts. Directs and conducts ongoing analysis of financial impacts and implementation of contract performance improvement strategies in accordance with BSWH business objectives.

A system Director translates and implements strategic plans and objectives for area of responsibility. Makes final decisions on operational matters and ensures achievement of objectives. Recommends policies and organizational changes for area. Plans and executes projects and initiatives that meet annual objectives. Erroneous decisions at this level tend to have negative impact on the success of the area, business unit, and possibly the overall organization's operations. Plans and directs the operations of a department or area, with responsibility for staffing, processes, budgets, and costs of the unit. Leads and advises subordinate(s) to meet schedules, resolve technical problems, and monitor performance. Has a larger, more complex organization or functional area than a manager. Often has one or more managers or supervisors reporting to the role.

ESSENTIAL FUNCTIONS OF THE ROLE

1. Directs managed care contracting and operations for BSWH.
2. Recommends and implements strategic and operational plans and priorities for managed care contracting aligned to BSWH overall business objectives.
3. Directs all managed care payer contracting, activities, and relationships, including payer resolution processes, contract negotiations, and contract performance.
4. Monitors and analyzes contract volumes and profitability against expected levels of performance.
5. Initiates operational improvements and contract modifications as needed.
6. Manages and resolves multi-faceted issues related to contract operational performance, interpretation, and payer obligations between organization and the managed care organization.
7. Promotes accountability of all internal and external stakeholders, and communicates and coordinates process initiatives, including communications of contracts to joint venture partners.
8. Ensures accuracy of managed care contract rates and language maintained in managed care databases.
9. Implements quality, process, and ongoing audit procedures and communicates findings and recommendations.
10. Monitors application of state and federal regulations that affect contract enforcement, including Texas Prompt Pay Act, ERISA, and COBRA.

KEY SUCCESS FACTORS

1. Bachelor's degree in healthcare, business, or related field.
2. 5+ years of experience with managed care strategy, contracts, or related area.
3. 1+ years of experience in a leadership role.
4. Experience in negotiation of managed care contracts.
5. Understanding of healthcare reimbursement concepts and managed care economic models.
6. Strong skills in negotiation, relationship building, and collaboration.
7. Strong project management and process orientation.
8. Excellent written, verbal, and presentation skills.

BENEFITS

Our competitive benefits package includes the following
- Immediate eligibility for health and welfare benefits
- 401(k) savings plan with dollar-for-dollar match up to 5%
- Tuition Reimbursement
- PTO accrual beginning Day 1
Note: Benefits may vary based upon position type and/or level

QUALIFICATIONS

• EDUCATION - Bachelor's or 4 years of work experience above the minimum qualification
• EXPERIENCE - 5 Years of Experience

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