Senior Director, Provider Contracting - Denver Health Medical Plan (Must Live in Colorado. Weekly On Site Requirement)

Must live in Colorado. This is a hybrid role located in Denver, Colorado with a requirement of being in the office 3 days per week.

About the Role

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, value-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.

Responsibilities

• 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%)
• Identify network needs and manage 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, including interviewing, hiring, training employees, planning, assigning and directing work, appraising performance, rewarding and disciplining employees, and addressing complaints and resolving problems (5%)
• Special projects and other duties as assigned by the CFO (5%)

Requirements

• Bachelor's Degree, concentration in Finance, Accounting, Business, Management, or Healthcare Administration related field required
• 10+ years of contract management demonstrated experience required; provider contracting experience preferred
• 4-6 years of manager experience required, preferably in healthcare

Skills

• 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
• 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

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, vision plans in addition to employer-paid disability and life insurance
• Comprehensive well-being programs including 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) supporting internal career growth and advancement pathways
• Professional clinical advancement program and shared governance
• Public Service Loan Forgiveness (PSLF) eligible employer with free student loan coaching and assistance navigating the PSLF program
• National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer

Pay

$143,800.00 - $237,400.00 / yr

About Denver Health

Denver Health is an integrated, high-quality academic healthcare 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, 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 has provided millions in uncompensated care for the uninsured each year. Located near downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.