Regional Director of Payer Strategies - Remote

Employment Type: Full time (remote position)

Responsibilities

• Knows, understands, incorporates and demonstrates the mission, vision and values of Trinity Health in leadership behaviors, practices and decisions.
• Develops and executes managed care and commercial payer strategies in conjunction with RHM CFOs and CEOs within region.
• Negotiates regional managed care and commercial payer contracts utilizing consistent language and reimbursement methodologies; ensures contracts align with RHM strategies.
• Establishes and maintains active, positive relationships with senior leadership at hospitals, Revenue Excellence leadership, System Office leadership, and Trinity Health Legal to ensure communication regarding service level performance and issue resolution.
• Operationalizes and implements managed care contracts and contract updates at hospitals and within Revenue Excellence, including monitoring programs and denial management programs.
• Communicates and implements payer policy changes with hospitals and Revenue Excellence.
• Monitors compliance with payer requirements and provides additional training when needed.
• Monitors payer financial and operational performance; proactively implements payer corrective actions and improvement activities when required.
• Establishes and maintains active, positive relationships with payer senior leadership within region.
• Identifies opportunities for payer collaboration and implements collaborative programs.
• Serves as liaison between hospitals and payers within region.
• Provides regular payer reporting package, including payer report cards, to hospital C-Suite leaders and Revenue Excellence leadership.
• Develops and maintains market profiles of key payers, buyers, and brokers to assist in strategy development, decision-making, and proactive identification of managed care and health insurance trends.
• Develops, implements, and monitors payer pay-for-performance initiatives.
• Works with clinical leadership at hospitals to ensure maximum realization of revenue.
• Manages and mentors payer contracting staff within region.
• Prepares budgets and manages use of resources within budget targets.
• Maintains a working knowledge of applicable Federal, State, and local laws/regulations; the Trinity Health Integrity and Compliance Program and Code of Conduct; as well as other policies and procedures to ensure adherence in a manner that reflects honest, ethical, and professional behavior.

Leadership Competencies

As a Trinity Health Leader, the incumbent is expected to demonstrate leadership traits that support the following Mission Statement and Core Values:

Mission Statement: We, Trinity Health, serve together in the spirit of the Gospel as a compassionate and transforming healing presence within our communities.

• Reverence: We honor the sacredness and dignity of every person.
• Commitment to Those who are Poor: We stand with and serve those who are poor, especially those most vulnerable.
• Justice: We foster right relationships to promote the common good, including sustainability of Earth.
• Stewardship: We honor our heritage and hold ourselves accountable for the human, financial, and natural resources entrusted to our care.
• Integrity: We are faithful to those we say we are.

Requirements

• Comprehensive knowledge of healthcare finance, managed care, and insurer contracting, typically obtained through a Bachelor’s degree in Business Administration and eight to ten years of healthcare experience, with a significant portion involving managed care and other payers.
• Master’s in Business Administration or Master’s in Health Administration preferred, along with professional certification such as FHFMA, FACHE, or FAHM.
• Proven contract negotiation knowledge and skills.
• Strong analytical skills.
• Strong written and verbal communication skills.
• Ability to operate effectively in a collaborative, shared leadership environment.
• Personal presence characterized by honesty, integrity, and caring, with the ability to inspire and motivate others to promote Trinity Health’s philosophy, mission, vision, goals, and values.

Pay

Compensation range: $176,596 – $291,384