Executive Director, Payor Relations and Contracting
About City of Hope
City of Hope is an independent biomedical research and treatment organization for cancer, diabetes and other life-threatening diseases.
Founded in 1913, City of Hope is a leader in bone marrow transplantation and immunotherapy such as CAR T cell therapy. City of Hope’s translational research and personalized treatment protocols advance care throughout the world. Human synthetic insulin, monoclonal antibodies and numerous breakthrough cancer drugs are based on technology developed at the institution. AccessHope, a subsidiary launched in 2019 serves employers and their health care partners by providing access to City of Hope’s specialized cancer expertise.
A National Cancer Institute-designated comprehensive cancer center and a founding member of the National Comprehensive Cancer Network, City of Hope is ranked among the nation’s "Best Hospitals" in cancer by U.S. News & World Report and received Magnet Recognition from the American Nurses Credentialing Center. Its main campus is located near Los Angeles, with additional locations throughout Southern California, Arizona, Illinois and Georgia.
The Executive Director Relations and Contracting is responsible for leading execution of the payer strategy supporting the Phoenix market and advising leadership on matters related to the strategy. Responsibilities include all aspects of payer negotiations, managing the regional payer pricing portfolio, and the business relationships with regional payers. Develops annual plan for the City of Hope Arizona (COH AZ) managed care portfolio. Leads key regional payer negotiations with the goal of growing the contract portfolio, increasing patient access and advancing new payment models.
List the essential job responsibilities which are typically performed by this job and % of time spent on each:
- 10%:Partners with COH AZ leadership to develop and execute short and long-range plans, goals and objectives related to payer strategy, and growth and management of the region’s payer contract portfolio.
- 30%:Develop and improve relationships between COH AZ and payers in the Arizona market. Monitor payer related metrics and lead the development of interventions to continually improve access to COH AZ and improve payer contract performacnce. Collaborate cross functionally to understand COH AZ’s operational and revenue cyle issues with payers and partner with COH Legal to remedy contract breaches and large dollar claim issues.
- 5%:Monitor Medicare and Medicaid legislation impacting patient access and reimbursement which could impact commercial, Medicare Advantage and AHCCCS negotiations and contract performance.
- 5%:Assess and review risks and opportunities across the enterprise related to payment reform, bundled payments, value-based payments, etc.
- 5%:Analyze claim trend data and/or market information needed to support contract negotiations.
- 5%:Review and present financial data, utilization trends and patient mix needed to negotiate and re-negotiate payer contracts.
- 25%:Negotiate contractual and reimbursement terms with market payers utilizing contracting guidelines with respect to third party payer contractual terms, reimbursement, provider enrollment and product participation
- 5%:Maintain knowledge of payer products, enrollment statistics, and trends.
- 5%:Understand and stay abreast of issues and events that may have an impact on business and industry.
- 5%;Identify contracting / payer disputes that may require legal action.
Minimum of 10 years relevant hospital, medical group/IPA or payer contracting experience required, including managed care contracting experience with demonstrated ability in the areas of financial analysis, payment methodologies, contract language, negotiation strategy/tactics, relevant regulatory/compliance issues.
Education: Bachelor’s degree required
- Excellent verbal and written communication skills
- Outstanding negotiation skills
- Ability to collaborate with people at all levels of the organization
- Ability to maintain professionalism in difficult and sensitive conversations where stakeholders may disagree
- Strong critical thinking skills
- Outstanding organizational and analytical skills
- Knowledge and understanding of financial implications of reimbursement structures
- Demonstrated knowledge of managed care and value-based care principles
- Knowledge and experience with value-based contracting structures and contract language
- Knowledge of different healthcare rate structures and payment methodologies
Pay Range$163,214.69 - $285,929.28
Placement within the identified pay range is based on individual and market factors including, but not limited to, experience, education, credentials (including licenses and certifications), geographic location, market competition, skill set (including market availability of required skills), assigned/anticipated job tasks, and level of responsibility. These factors are considered without regard to an individual’s status as a member of any protect group pursuant to federal, state, and/or local law.
City of Hope’s commitment to Diversity, Equity, and Inclusion
We believe diversity, equity and inclusion is key in serving our mission to provide compassionate patient care, drive innovative discovery, and advance vital education focused on eliminating cancer and diabetes in all of our communities. Our commitment to Diversity, Equity and Inclusion ensures we bring the full range of skills, perspectives, cultural backgrounds, and experiences to our work -- and that our teams align with the people we serve in order to build trust and understanding. We are dedicated to fostering a community that embraces diversity - in ideas, backgrounds, and perspectives; this is reflected in our work and represented in our people.
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Job Status: Full Time
Job Reference #: JR-10386