Director of Contracting and Operations

JOB SUMMARY

The Director of Contracting and Operations is responsible for planning, developing, and implementing new and existing managed care contracts for Baylor Scott and White Health (BSWH). This includes contract development, negotiation, interpretation, and compliance. The role monitors financial and operational performance of existing managed care contracts, negotiates and administers contracts, contract rates, and terms with managed care payers. The Director serves as a strategic point of contact with managed care payers and consumers impacted by the operational aspects of managed care contracts, ensuring compliance with contract terms. Furthermore, the Director conducts ongoing analysis of financial impacts and implements contract performance improvement strategies in alignment with BSWH business objectives.

A system Director translates and implements strategic plans and objectives for their area of responsibility, making final decisions on operational matters and ensuring achievement of objectives. They recommend policies and organizational changes, plan and execute projects that meet annual objectives, and have a significant impact on the success of the area and overall organization. The Director also plans and directs operations of a department or area, overseeing staffing, processes, budgets, and costs. They lead and advise subordinates to meet schedules, resolve technical problems, and monitor performance.

ESSENTIAL FUNCTIONS OF THE ROLE

1. Directs managed care contracting and operations for BSWH.
2. Recommends and implements strategic and operational plans and priorities for managed care contracting aligned to BSWH overall business objectives.
3. Directs all managed care payer contracting, activities, and relationships, including payer resolution processes, contract negotiations, and contract performance.
4. Monitors and analyzes contract volumes and profitability against expected levels of performance.
5. Initiates operational improvements and contract modifications as needed.
6. Manages and resolves multi-faceted issues related to contract operational performance, interpretation, and payer obligations.
7. Promotes accountability of all internal and external stakeholders, coordinating process initiatives, including communications of contracts to joint venture partners.
8. Ensures accuracy of managed care contract rates and language maintained in managed care databases.
9. Implements quality, process, and ongoing audit procedures, communicating findings and recommendations.
10. Monitors application of state and federal regulations affecting contract enforcement, including Texas Prompt Pay Act, ERISA, and COBRA.

KEY SUCCESS FACTORS

1. Bachelor's degree in healthcare, business, or related field.
2. 5+ years of experience with managed care strategy, contracts, or related area.
3. 1+ years of experience in a leadership role.
4. Experience in negotiation of managed care contracts.
5. Understanding of healthcare reimbursement concepts and managed care economic models.
6. Strong skills in negotiation, relationship building, and collaboration.
7. Strong project management and process orientation.
8. Excellent written, verbal, and presentation 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.

QUALIFICATIONS

• EDUCATION - Bachelor's or 4 years of work experience above the minimum qualification.
• EXPERIENCE - 5 Years of Experience.

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