The Strategic Payer Relations Analyst position is responsible for managing and maintaining AHH’s medical contracts. Under the direction of the Revenue Cycle Practice Director, this position shall support the business development and strategy for all commercial, managed care and governmental payer relationships. This position will manage the responsibility of contracting with all payers, including contracts for value-based arrangements (VBA) and traditional fee-for-service (FFS) contracts, and coordinating the contract terms with the applicable departments for implementation of all contracts. This role will help in identifying and prioritizing payer relationships, assessing risk profiles, and negotiating optimal risk-based contracts with health plans, including contract review, negotiation of terms, and strategic positioning. They will be responsible for negotiating contracts for related entities for the Arkansas Heart Hospital system.
Position Responsibilities: (and other duties as assigned)
- Responsible for both leading and supporting payer negotiations with an emphasis on building strong, collaborative payer relationships that support innovative reimbursement structures to advance the best interest of high quality, affordable patient care.
- Provide strategic leadership regarding value-based and fee-for-service contracting initiatives.
- Form strong, collaborative, working relationships across multiple payer organizations to advance innovative reimbursement arrangements that support advancement of quality and affordability of care.
- Maintain reports on volume, financial performance, and profitability of each insurance contract.
- Address fiscal integrity of contract and minimize risks.
- Assist with resolution of operational, billing, and credentialing problems with payers.
- Maintain contracting calendars and/or contract dashboard to ensure adherence to key contract dates/times related to contract requirements, adjustments and/or renewals.
- Manage/maintain new site and department enrollments/certifications.
- Interact with providers to reinforce AHH’s expectations of providers regarding services to AHH members and quality improvement expectations.
- Work with network providers to assure cultural competency, compliance with quality metrics and adherence to AHH utilization requirements.
- Facilitate the development of contracting terms to include incentives for provider performance consistent with CMS Value Based Purchasing and other CMS or DHS provider incentive payment programs.
- Perform annual assessment of current fee schedule per HRSA recommendations to ensure fees are covering costs and maximizing reimbursement.
- Develop and maintain contract summaries including performance targets and measures of matrix, timelines, contract requirements and deadlines.
- Monitor and manage payer compliance issues including rosters, assignment, reports, delivery dates, fees, audits.
- Monitor and analyze changes in payer fee-for-service programs and policies that may affect contract performance and initiate negotiations as warranted.
- Participate in and report to Executive leadership groups; provide support for these meetings.
- Create strategic alliances with internal and external groups to maximize member and payer relations and all payer contract performance.
- Other duties as assigned.
- Education: Bachelor’s degree in Health Care Administration, Business, Economics, or a related field is required. MBA and/or JD preferred.
- Experience: Minimum of two years of experience in contract negotiations, preferably within provider and/or payer settings, with at least one or more (1+) years of experience or knowledge of managed care, healthcare economics, managed care pricing, product/network development or management.
- Demonstrated track record of building strong working relationships across operational leaders and potential payer partners.
- Strong understanding of Medicare reimbursement, Medicare Advantage health plan economics, and value-based and contracting models, including legal and regulatory considerations.