Director - Payor Relations & Contracting
Cincinnati Children's Hospital Medical Center

Job Description

At Cincinnati Children's, we come to work with one goal: to make children's health better. We believe in a holistic team approach, both in caring for patients and their families, and in advancing science and discovery. We strive to do better and find energy and inspiration in our shared purpose. If you want to be the best you can be, you can do it at Cincinnati Children's.

Cincinnati Children's Hospital Has Been Named:

• The #1 Pediatric Hospital in the Nation - US News and World Report 2023
• One of four Medical Centers making the list of the 2022 Glassdoor Best Places to Work
• A Top Hospital and Health System for Diversity recognized by DiversityInc
• One of the nation's most innovative companies by Fortune in March 2023
• An LGBTQ+ Healthcare Equality Top Performer in 2022 by The Human Rights Campaign (HRC)

JOB RESPONSIBILITIES

• Contracting & Negotiations- Lead department and other internal staff and all applicable contract administrators to negotiate favorable contractual terms for Cincinnati Children's and/or the PHO. Coordinate third party payer contract negotiation activities including acting as a liaison to and resource for internal operations and affiliates regarding third party payer contracting. Prepare and implement annual contracting plan for CCHMC and PHO. Participate in the development of new business programs/ventures that include new payment arrangements with third party payers and employers.
  
• Contract Management & Payer Compliance- Develop and maintain systems for oversight and monitoring payer compliance with contracts in order to insure accurate and complete payment to CCHMC for all services covered in contracts with third party payers. Work with Finance and clinical departments/divisions/Institutes to monitor third party payers' compliance with contract terms and payment rates and provide assistance in turning over payer denials, develop contract management tools and systems for internal use and assist with the financial, operational and delivery aspects of third-party payer and provider contracts.
  
• Payer Relations- Develop and maintain appropriate working relationships with decision-makers and operating/clinical departments of third-party payers, insurance companies, employers, federal, state, local international government and private payers. Conduct presentations and market Cincinnati Children's and PHO to third party payers, government officials, and employers.
  
• Data Analysis & Pricing- Develop analytical reports to demonstrate the financial impact of proposed arrangements for physician, hospital, and PHO contracts. Monitor and continually evaluate third party payer contracts. Review all contract fee schedules annually for appropriateness and compliance. Assist in development of regular benchmarking reports of pricing and reimbursement. Recommend annual fee schedule changes and pricing policies.
  
• Financial Management- Manage the annual operating expense budgets of departments/costs centers reporting to position.
  

JOB QUALIFICATIONS

• Master's degree in a related field
  
• MBA or MHA
  
• 5+ years of work experience in a related job discipline
  

Market Leading Benefits Including:

• Shift Differential, Weekend Differential, and Weekend Option Pay Programs
  
• Medical coverage starting day 1 of employment. View employee benefits here.
  
• Competitive retirement plans
  
• Tuition reimbursement for continuing education
  
• Expansive employee discount programs through our many community partners
  
• Referral bonus program for current staff!
  
• Support through Employee Resource Groups such as African American Professionals Advisory Council, Asian Cultural and Professional Group, EQUAL - LGBTQA Resource Group, Juntos - Hispanic/Latin Resource Group, Veterans and Military Family Advocacy Network, and Young Professionals (YP) Resource Group
  
• Physical and mental health wellness programs
  
• Relocation assistance packages available for nurses!
  

Primary Location
South Campus

Schedule
Full time

Shift
Day (United States of America)

Department
Payor Relations

Employee Status
Regular

FTE
1

Weekly Hours
40

Salary Range
$111,155.20 - $142,043.20

Comprehensive job description provided upon request.

Cincinnati Children's is proud to be an Equal Opportunity Employer that values and treasures Diversity, Equity, and Inclusion. We are committed to creating an environment of dignity and respect for all our employees, patients, and families. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, genetic information, national origin, sexual orientation, gender identity, disability or protected veteran status. EEO/AA/M/F/Veteran/Disability.

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