Director of Payor Relations
- Req. Number: 18280
- Address: 3113 Bellevue Ave
- City, State: Cincinnati, OH
- Job Type: Full time
- Posted Date: 3/17/2025
Job Description
At UC Health, we're proud to have the best and brightest teams and clinicians collaborating toward our common purpose: to advance healing and reduce suffering.
As the region's adult academic health system, we strive for innovation and provide world-class care for not only our community, but patients from all over the world. Join our team and you'll be able to develop your skills, grow your career, build relationships with your peers and patients, and help us be a source of hope for our friends and neighbors.
UC Health is committed to providing an inclusive, equitable and diverse place of employment.
Responsible for planning, directing negotiating, and coordinating external relations with payers on behalf of UC Health hospitals, UC Physicians, and UC Health related entities. Provides leadership in setting negotiation strategy taking into account UC Health's strategic plan, UC Health's business objectives, and market dynamics. Is a resource to various internal stakeholders including finance operations, revenue cycle management, corporate compliance, case management, and others with respect to existing managed care contracts, insurance regulation, and government healthcare programs.
Responsibilities
Resolve disputes arising between UC Health providers and managed care plans with respect to timely and accurate adjudication of claims, payment denials, and all other aspects of the contractual relationship. Disputes are brought to the attention of the Director by Payor Relations contract compliance auditors, UC Health revenue cycle, UC Physicians revenue cycle, hospital finance, hospital operations, Lindner Center of Hope, and corporate financial operations.
30% Negotiate managed care network participation agreements on behalf of all UC Health providers including UC Health facilities, UC Physicians, and Lindner Center of Hope, with commercial managed care plans and government managed care plans operating in Ohio, Kentucky, and Indiana. Requires negotiation skills, ability to work with internal stakeholders to establish negotiation objectives, ability to draft contract language, ability to interpret contract language, and ability to interpret relevant statutes, regulations, and government rules. -
20% Respond to questions from UC Health stakeholders about contract interpretation. Such UC Health stakeholders include revenue cycle, financial operations, financial accounting, hospital operations, the general counsel's office, internal audit, corporate compliance, UC Physicians business managers, UC Physicians revenue cycle, and Lindner Center of Hope.
20% Monitor developments in the Ohio, Kentucky, and Indiana Medicaid programs; and the Medicare program. Attend meetings of Ohio Medicaid large provider group, the Ohio Hospital Association admitting, billing, and collections committee, and similar groups. Be familiar with federal health and welfare benefit regulations, state of Ohio insurance regulations. Medicaid managed care statutes and rules, and Medicare statutes and rules. Use the knowledge acquired to improve performance of managed care agreements. -
15% Provide direction in hospital contract negotiations to Payor Relations contracting managers; and in compliance activities to Payor Relations CCE Auditors. Develop revenue management and enhancement strategies by payor; and oversight of activities related to payor operational meetings.
10% Complete other operational or data analytic functions as needed to meet the goals of the department.
5% Review the physical demands and assign an overall average percentage of time this position performs these activities.
Qualifications
Minimum Required: Bachelor's degree in business, finance or related field required.
Preferred: Master's Degree MBA, MHA, or JD preferred.
Minimum Required: 3 - 5 Years equivalent experience.
Preferred: 6 - 10 Years equivalent experience
At UC Health, we're proud to have the best and brightest teams and clinicians collaborating toward our common purpose: to advance healing and reduce suffering.
As the region's adult academic health system, we strive for innovation and provide world-class care for not only our community, but patients from all over the world. Join our team and you'll be able to develop your skills, grow your career, build relationships with your peers and patients, and help us be a source of hope for our friends and neighbors.
UC Health is committed to providing an inclusive, equitable and diverse place of employment.
Responsible for planning, directing negotiating, and coordinating external relations with payers on behalf of UC Health hospitals, UC Physicians, and UC Health related entities. Provides leadership in setting negotiation strategy taking into account UC Health's strategic plan, UC Health's business objectives, and market dynamics. Is a resource to various internal stakeholders including finance operations, revenue cycle management, corporate compliance, case management, and others with respect to existing managed care contracts, insurance regulation, and government healthcare programs.
Responsibilities
Resolve disputes arising between UC Health providers and managed care plans with respect to timely and accurate adjudication of claims, payment denials, and all other aspects of the contractual relationship. Disputes are brought to the attention of the Director by Payor Relations contract compliance auditors, UC Health revenue cycle, UC Physicians revenue cycle, hospital finance, hospital operations, Lindner Center of Hope, and corporate financial operations.
30% Negotiate managed care network participation agreements on behalf of all UC Health providers including UC Health facilities, UC Physicians, and Lindner Center of Hope, with commercial managed care plans and government managed care plans operating in Ohio, Kentucky, and Indiana. Requires negotiation skills, ability to work with internal stakeholders to establish negotiation objectives, ability to draft contract language, ability to interpret contract language, and ability to interpret relevant statutes, regulations, and government rules. -
20% Respond to questions from UC Health stakeholders about contract interpretation. Such UC Health stakeholders include revenue cycle, financial operations, financial accounting, hospital operations, the general counsel's office, internal audit, corporate compliance, UC Physicians business managers, UC Physicians revenue cycle, and Lindner Center of Hope.
20% Monitor developments in the Ohio, Kentucky, and Indiana Medicaid programs; and the Medicare program. Attend meetings of Ohio Medicaid large provider group, the Ohio Hospital Association admitting, billing, and collections committee, and similar groups. Be familiar with federal health and welfare benefit regulations, state of Ohio insurance regulations. Medicaid managed care statutes and rules, and Medicare statutes and rules. Use the knowledge acquired to improve performance of managed care agreements. -
15% Provide direction in hospital contract negotiations to Payor Relations contracting managers; and in compliance activities to Payor Relations CCE Auditors. Develop revenue management and enhancement strategies by payor; and oversight of activities related to payor operational meetings.
10% Complete other operational or data analytic functions as needed to meet the goals of the department.
5% Review the physical demands and assign an overall average percentage of time this position performs these activities.
Qualifications
Minimum Required: Bachelor's degree in business, finance or related field required.
Preferred: Master's Degree MBA, MHA, or JD preferred.
Minimum Required: 3 - 5 Years equivalent experience.
Preferred: 6 - 10 Years equivalent experience
