Under the general supervision of the Associate CFO, Revenue Cycle, the Associate Director Payer Contracting is responsible for developing and implementing new and established contracts for facility and professional agreements with third party payers on behalf of Denver Health & Hospital Authority, including new programs and services. This role will lead negotiations with assigned payers to include payment terms based on multiple reimbursement models, including fee-for-service payment terms, valued based payments and gain/risk sharing arrangements. The Associate Director will be accountable for negotiating contract language that aligns with all State and Federal laws/regulations and organizational policies. This position will be responsible for development and maintain of revenue integrity functions consistent with the mission and vision of Denver Health & Hospital Authority.
1. Oversee organizational contract development and management activities and enforce organizational principles of integrity and compliance2. Develop standards for contracts, including payment terms, general language and provisions based on strategy discussions, senior management input and organizational needs 3. Evaluate rate proposals, changes to reimbursement methodologies and conduct related analyses to ensure continued financial viability of the contract4. Ensures contracts and proposals are properly entered into organizational databases to measure, track and monitor utilization and financial performance of managed care contracts5. Negotiate single case agreements to capture financial reimbursement from non-contracted entities6. Serve as primary organizational contact during payer contract negotiations7. Assist HPBS Department and internal customers with resolution of complex payer issues. Participate in JOC meetings with third party payers to address contractual payment issues and trends 8. Communicate and provide tools for contractual terms to other departments whose functions are necessary to the development, implementation and management of the provider arrangements.9. Responsible for the credentialing of Denver Health facilities which includes all associated clinics and new business ventures10. Maintain knowledge and understanding of healthcare industry trends, standards, and current events relative to provider contracting, network administration and market11. Oversee the operation performance of a system-wide, service line-based Charge Review program to identify charge capture and DRG validation improvement opportunities to minimize revenue leakage12. Provides data analytics and reporting to HPBS Department to identify potential process improvement in charge capture functions to maximize net reimbursement 13. Serves as the revenue integrity liaison for HPBS Department and revenue producing departments14. Carry out supervisory responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems15. Special projects/ other duties as assigned by the Associate CFO- Revenue Cycle/ Hospital and Physician Billing Services
Knowledge, Skills & Abilities
Knowledge, Skills and Abilities1. Strong knowledge of Managed Care contracts is required. 2. Advanced understanding of CPT, HCPCS, ICD-10 and various reimbursement methodologies such as Medicare/ Medicaid and third party billing requirements. 3. Extensive knowledge and experience with Medicare/ Medicaid regulations.4. Excellent negotiating skills and proficiency in utilizing and interpreting financial models and analysis.5. Experience with APC reimbursement, CMS rules and regulations, coding and billing compliance.6. Strong working knowledge of billing and collection processes and functions, charging processes and general revenue cycle management strategies and industry best practices.7. Requires high attention to detail, analytical and critical thinking, management skills, organization, prioritization and problem resolution.8. Excellent verbal and written communication, leadership, delegation, collaboration and interpersonal skills9. Ability to be resourceful, customer-service oriented and independently problem-solve is required.Computers and Technology1. Utilizes software applications and working knowledge of the following information systems to include accessing information, updating, correcting and/ or deleting data. General knowledge related to various software applications and their capabilities. Microsoft Office applications: Word, Excel, Access, PowerPoint and Outlook and other applications as needed. Certificates, Licenses and Registration1. None
Bachelor's Degree (Required) Concentration in Finance, Accounting, Business, Management, Healthcare Administration related field preferred.
Six years Contract Management demonstrated experience with large Managed Care systems required. 3. Two years of manager experience required, preferably in healthcare.
Work Type Full time
All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made.
Denver Health is an integrated, efficient, high-quality academic health care system that is considered a model for the nation. The Denver Health system includes the Rocky Mountain Regional Level I Trauma Center, a 525-bed acute care medical center, Denver's 911 emergency medical response system, 8 family health centers, 15 school-based health centers, the Rocky Mountain Poison and Drug Center, the Denver Public Health Department, an HMO, and The Denver Health Foundation.
As Colorado's primary safety net institution, Denver Health is a mission-driven organization that has provided more than $3.3 billion in care for the uninsured in the last ten years. Denver Health is a leader in performance and quality improvements and remains financially secure, in part, due to its nationally recognized implementation of lean principles in healthcare. Denver Health is a major resource to the community, serving approximately 185,000 individuals and 67,000 children a year.
Located just south of downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.
We strongly support diversity in the workforce and Denver Health is an equal opportunity employer (EOE).
"Denver Health is committed to provide equal treatment and equal employment opportunities to all applicants and employees. Denver Health is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class."
Internal Number: 3667
About Denver Health
Take your career to the next level at Denver Health, where we offer a robust benefits package and endless opportunities for growth. Denver Health is a nationally-ranked, locally-trusted, premier healthcare institution located in the heart of Denver, Colorado.Twenty-five percent of all Denver residents, or approximately 150,000 individuals, receive their health care here. We are known as an integrated health care system that encompasses multidisciplinary academic specialties, a community health system, a level I adult trauma center, pediatric emergency and urgent care center home to Denver Public Health and many of the nation’s leaders in medicine.