Director- Payer Relations Full Time Days at East Tennessee Children's Hospital – Knoxville, Tennessee
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About This Position
Location: Hybrid | Knoxville, TN
Req ID: JR102961
Job Type: Full time
Posted Date: Posted Yesterday
Description:
BASIC PURPOSE OF THE JOB
Accountable for Dolly Parton Children's Hospital enterprise-wide payer relationships including payer contracting, credentialing, delegated credentialing, recredentialing, network enrollment, Joint Operating Committees and problem resolution on behalf of Dolly Children's, our MDs & Non-MDs, Home Health, Specialty Pharmacy, Behavioral Health, and Dolly Children's Urgent Care and any new lines of business Dolly Parton Children's Hospital enters. Provides executive oversight to departmental activities to ensure quality in conducting and communicating physician credentialing, privileging, source verifications, enrollment and payer effective dates. Coordinates with the Director of Contract Analytics for payer negotiations, issue resolutions, and escalations.
REPORTS TO
• Chief Financial Officer
JOB REQUIREMENTS
Supervisory Responsibilities: Yes
Minimum Education: Bachelor's Degree
License/Certification Required: None
Minimum Work Experience: 10
• 5-year experience in facility and physician managed care contracting.
• 5-year experience in Physician Hospital Organization contracting.
REQUIRED KNOWLEDGE, SKILLS, AND ABILITIES
• Excellent written and verbal communication skills.
• Excellent negotiator
• Superior attention to detail.
• Highly experienced and proficient in MS Office Suite: Word, Excel, PowerPoint, Outlook.
DUTIES AND RESPONSIBILITIES
• Continuous renegotiation of Tenncare MCOs and commercial payers for Dolly Children's, our MDs & Non-MDs, Home Health, Specialty Pharmacy, Behavioral Health, and Dolly Children's Urgent Care.
• Ownership of Dolly Children's credentialing, recredentialing, network enrollment, delegated credentialing, credentialing audits and provider and payer problem resolution activities.
• Episode of Care and PCMH annual contract renewals
• Engage with and support revenue cycle opportunities and business analytics and other Dolly Children's departments are needed.
• Develop payer credentialing committee and policies and procedures for ETCMG
• Engage with new specialty pharmacy/pharmacist contracting opportunities
• Maintain Joint Operating Committees with large payers
• Develop payer and provider price transparency strategy
• Shared leadership in Dolly Children’s Engagement with THA and TennCare
o Represent Dolly Parton Children's Hospital in the THA’s Managed Care Taskforce.
o Serve as the primary lead on assessing and addressing the implications and impacts of TennCare’s annual hospital assessment and rate improvement initiatives, specific to the proposed use of 340B rate caps, rate variation repeal and use of average commercial rates, quality components, and revised out-of-network rate methodologies.
o Provide regular updates to key Dolly Children's stakeholders.
o Review and advise on potential new rate agreements between Dolly Children's, THA, and TennCare
• Evaluate payer network options for Dolly Parton Children's Hospital
• Maintain Dolly Children's as an in network provider with as many networks as deemed necessary
• Keep abreast of current trends and developments in healthcare delivery and managed care. Monitor local, state, and national legislation that could impact the organization and its participants.
• Prepare for Board of Director meetings.
• Perform other tasks and assume other responsibilities as the Board may from time to time assign on a temporary or permanent basis.
PHYSICAL REQUIREMENTS
• Note: Reasonable accommodations may be made for individuals with disabilities to perform the essential functions of this position.
• Light lifting, pushing, and pulling is required for 10-20 lbs. occasionally and frequent moving of objects of less than 10 lbs. is required. Frequent sitting with some walking, standing, squatting, bending, and reaching is required. Keyboard/computer/scanner/copier/printer use and/or repetitive motions may be required.
Come work where you can make a difference everyday.
About Us:
At Dolly Parton Children’s Hospital, care is at the CORE of who we are. We are comprised of team members who live out our core values of Compassion, Ownership, Respect, and Excellence. We support each other by fostering a culture of team engagement that creates moments that matter – every interaction, every time.
Compassion – We imagine what others are going through, work to alleviate suffering, and create joy whenever possible.
Ownership – We take pride in our work, act with integrity, and feel personal responsibility for achieving our mission.
Respect – We listen, understand, and communicate openly and politely. We recognize our diverse strengths.
Excellence – We set high standards for performance in delivering the safest patient care. We give extraordinary and meaningful experiences to our patients, their families, team members, and the community we serve.