Job Description

General Summary

Is responsible for oversight of the Payor Contract Analyst (PCA) Team; coordinating and facilitating the maintenance and management of payor relationships on behalf of WellSpan Health, as well as the operational management of the Wellspan System contracts. This includes being a resource in the support of the Payor Contract Analysts and other functional areas that deal directly with payors. Facilitates planning and decision making and is responsible, within defined scope, for the day-to-day operation of the PCA team. Participates in a variety of financial projects including attending interdepartmental meetings to address financial trends associated with payor noncompliance.

Duties and Responsibilities

Essential Functions:

• Coordinates and facilitates the maintenance and management of payor relationships on behalf of WellSpan Health by serving as a facilitator to provide management support. Acts as resource for payor contracting personnel. Participates and coordinates learning events and training. Participates in the development and maintenance policies relating to operations of departments. Completes the staff's performance evaluations. Provides support of existing payor relationships on all contracts including handling of all operating issues.
• Identifies operational/denial root causes and processes and works collaboratively with other departments to improve processes when control, operational weaknesses and/or compliance issues are found. Leads improvement initiatives utilizing Lean principles to improve operational and/or financial efficiency of System entities.
• Provides oversight and governance Payor Research Information Request process and the investigation of revenue processes, including billing system errors, to ensure systems are optimizing reimbursement while maintaining compliance with applicable rules and policies.
• Participates in the management of payor relationships, integrating contract changes into appropriate clinical areas and managing payor issues with periodic payor meetings. Attends, either in person or virtually, JOC meetings between Payors and the System.
• Leads the PCA team as they coordinate all System payor policy changes through communication with all applicable departments.
• Works with Payor Contracting Analysts to maintain payment terms and conditions of Commercial and Government contracts and supports Payor Contracting Analysts in addressing contract-related issues on behalf of internal departments.
• Assists the Director in the collection and maintenance of performance measure information relative to value-based contract payment terms and voluntary pay for performance programs.
• Manages contractual notification requirements as defined by contract language for new service additions to the WellSpan Health delivery system.
• Responsible for facility credentialing/re-credentialing for Summit Health for Commercial, Medicare Advantage Products and PA Medicaid MCOs.
• Participates in interdepartmental meetings to coordinate improvement in the hospital's revenue cycle.
• Assists the Senior Director of Payor Contracting and VP of Payor Contracting and in financial analysis and/or other requested projects.

Common Expectations:

• Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest trends in field of expertise.
• Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.

Qualifications

Minimum Education:

• Bachelors Degree In HealthCare, Business or other related field Required

Work Experience:

• 3 years payor or provider contracting, Accounting, Patient Accounting, Government Regulations, Required and
• Supervisory experience Required

Knowledge, Skills, and Abilities:

• Able to communicate and work effectively with payors in finding negotiable solutions out of presented problems;
• Able to communicate and work well with staff and other departments implementing change and the exchange of feedback across the organization;
• Excellent written and oral communications and interpersonal skills; computer skills.

Benefits Offered:

• Comprehensive health benefits
• Retirement savings plan
• Paid time off (PTO)
• Education assistance
• Financial education and support, including DailyPay
• Expanded Paid Parental Leave

For additional details: Benefits & Incentives | WellSpan Careers (joinwellspan.org)