Manager, Payer Contracting - Hybrid - Must Reside in Colorado

We're with you for life’s journey. At Denver Health, purpose isn’t just something we believe in—it’s something we live every day, for life’s journey.

Our Values

• Respect
• Belonging
• Accountability
• Transparency

About the Role

Under the general supervision of the Chief Financial Officer, Director of Payer Contracting, or Associate CFO, the Manager Payer Contracting is responsible for developing and implementing new and established contracts for facility and professional agreements with third party payers on behalf of Denver Health & Hospital Authority, including new programs and services. This role will lead negotiations with assigned payers to include payment terms based on multiple reimbursement models, such as fee-for-service, value-based payments, and gain/risk-sharing arrangements. The Manager will be accountable for negotiating contract language that aligns with all State and Federal laws/regulations and organizational policies.

The position will also supervise staff who analyze payer contracts, monitor payer performance to contract and underpayments, track changes in payer policies that might impact rates, and ensure appropriate implementation and maintenance of contracts. This includes working with internal stakeholders, convening and facilitating workgroups, and ensuring contracts are implemented timely and correctly. The role covers all payers including commercial, Medicare Advantage, correctional, and some governmental/Medicaid contracts such as Colorado Access.

Responsibilities

• Oversee organizational payer contract proposals and maintenance with payers and internal stakeholders (20%).
• Serve as primary organizational contact during payer contract negotiations on assigned contracts.
• Develop standards for contracts, including payment terms, general language, and provisions based on strategy discussions, senior management input, and organizational needs (10%).
• 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 of managed care contracts (10%).
• Negotiate single case agreements to capture financial reimbursement from non-contracted entities (10%).
• Ensure correct provider rosters for all commercial payers, including facilitating internal meetings to ensure timely uploads and resolution of roster issues (10%).
• Assist HPBS Department and internal customers with resolution of complex payer issues; participate in JOC meetings with third-party payers to address contractual payment issues and trends (5%).
• Communicate and provide tools for contractual terms to other departments whose functions are necessary for the development, implementation, and management of provider arrangements (5%).
• Responsible for the credentialing of Denver Health facilities, including all associated clinics and new business ventures (5%).
• Provide data analytics and reporting to the HPBS Department to identify potential process improvements in charge capture functions to maximize net reimbursement (5%).
• Carry out supervisory responsibilities, including interviewing, hiring, training, planning, assigning, and directing work; appraising performance; addressing complaints; and resolving problems (5%).
• Handle special projects and other duties as assigned by the supervisor (5%).

Requirements

• Bachelor’s Degree in Finance, Accounting, Business, Management, Healthcare Administration, or a related field (required).
• Master’s Degree in a related field (preferred).
• 5-7 years of contract management experience with large Managed Care systems, either with a provider, payer, or a mix (required).

Skills

• Strong knowledge of Managed Care contracts.
• Advanced understanding of CPT, HCPCS, ICD-10, and various reimbursement methodologies such as Medicare/Medicaid and third-party billing requirements.
• Extensive knowledge and experience with Medicare/Medicaid regulations.
• Excellent negotiating skills and proficiency in utilizing and interpreting financial models and analysis.
• Experience with APC reimbursement, CMS rules and regulations, coding, and billing compliance.
• Strong working knowledge of billing and collection processes, charging processes, and general revenue cycle management strategies and industry best practices.
• 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.
• Working knowledge of Microsoft Office applications: Word, Excel, Access, PowerPoint, and Outlook.

Pay

$89,000.00 - $137,900.00 per year

Benefits

• Paid time off starting at 28 days per year, inclusive of vacation, personal/sick, and 7 holidays.
• 100% paid parental leave up to 6 weeks.
• Immediate eligibility for retirement plans with employer contribution up to 9.5%.
• Generous medical, dental, and vision plans, plus employer-paid disability and life insurance.
• Comprehensive well-being programs, including an on-site employee fitness center and nationally recognized RESTORE Center.
• Free RTD EcoPass (public transportation).
• Childcare discount programs and exclusive perks on large brands, travel, and more.
• Tuition reimbursement and assistance.
• Education, coaching, and professional development opportunities through the Workforce Development Center (WFDC).
• Professional clinical advancement program and shared governance.
• Public Service Loan Forgiveness (PSLF) eligible employer with free student loan coaching.
• National Health Service Corps (NHSC) and Colorado Health Service Corps (CHSC) eligible employer.

About Denver Health

Denver Health is an integrated, high-quality academic healthcare system considered a model for the nation. It 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, the Public Health Institute at Denver Health, Denver Health Medical Plan, and Denver Health Foundation. As Colorado’s primary and essential safety-net healthcare system, Denver Health is a mission-driven organization that provides millions in uncompensated care for the uninsured each year. Located near downtown Denver, Denver Health is just minutes away from many cultural and recreational activities.