JOB SUMMARY

The Director of Contracting and Operations is accountable for planning, development, and implementation of new and existing managed care contracts for Baylor Scott and White Health (BSWH). Monitors financial and operational performance of existing managed care contracts. Negotiates and administers contracts with managed care payers. Directs and manages contract drafting, contract negotiations, and contract maintenance activities. Serves as strategic point of contact with managed care payers and consumers impacted by the operational aspects of managed care contracts. Ensures managed care organizations are compliant with the terms of the managed care contracts and for the ongoing testing of profitability and implementation of contract performance improvement strategies.

ESSENTIAL FUNCTIONS OF THE ROLE

• Oversees all managed care payer programs, activities, and relationships, including Joint Operations Committee Meetings, payer resolution processes, contract negotiations, and contract performance.
• Monitors contract volumes and studies profitability against expected levels of performance and initiates operational and/or contract modifications as appropriate.
• Manages and resolves multi-faceted issues related to contract operational performance, interpretation and payer obligations between organization and the managed care organization.
• Promotes accountability of all internal and external stakeholders, and communicates and coordinates process initiatives, including communications of contracts to joint venture partners.
• Ensures accuracy of managed care contract rates and language maintained in Managed Care databases and claims payment systems, implements associated quality, process, and ongoing audit procedures.
• Maintains excellent working knowledge and application of state and federal regulations that affect contract enforcement, including Texas Prompt Pay Act, ERISA, and COBRA.
• Maintains current knowledge of functions through reading literature, attending workshops, seminar, conferences and participating in professional organizations.
• Interviews, hires, trains, counsels, evaluates, and runs assigned executive, managerial, supervisory, and administrative help staff.

KEY SUCCESS FACTORS

• Bachelor’s degree in healthcare, business, or related field.
• 5+ years of experience with managed care contracts, or related healthcare finance role. 7+ years preferred.
• 1+ years of experience in a leadership role. 3+ years preferred.
• Demonstrated experience financial reporting and testing, operational budgeting, and financial planning.
• Knowledge of healthcare reimbursement concepts and economic models.
• Excellent written and verbal communication skills.
• Skills in leadership, including team development, strategic planning, and prioritizing.
• Excellent skills in negotiation, relationship building, and partnership.
• Excellent project management and organization skills.

BENEFITS

Our competitive benefits package includes the following

• Immediate eligibility for health and welfare benefits
• 401(k) savings plan with dollar-for-dollar match up to 5%
• Tuition Reimbursement
• PTO accrual beginning Day 1

Note: Benefits may vary based upon position type and/or level