Inspire health. Serve with compassion. Be the difference.

Job Summary

Essential Functions

• All team members are expected to be knowledgeable and compliant with Prisma Health’s values: Inspire health. Serve with compassion. Be the difference.
• Leads the development and management of key payor relationships between Prisma Health and all managed care organizations. Represents Prisma Health in multi-state industry coalitions in support of favorable payor policy development and implementation.
• Coordinates with a network of clinical, finance, and compliance professionals to ensure payor compliance with all regulatory and contractual requirements to optimize contract performance. Partners with revenue cycle, legal, and operational leadership to mitigate risk and address reimbursement challenges.
• Leads in-depth market research initiatives for industry, market, and regulatory trends to assess competitive reimbursement benchmarks and emerging industry trends. Provides support, education, and advocacy regarding issues of healthcare reimbursement.
• Serves as the division leader for all new service development, joint ventures, and new sites of care.
• Works collaboratively with departmental, organizational, and executive leadership to ensure correct and complete load of all contractual terms and provider enrollment activities.
• Fosters an employee culture that supports the Managed Care, Corporate Finance, and Prisma Health strategic and financial goals. Establishes training and network programs focused on enhancing employee job knowledge and ability. Establishes individual performance expectations for direct reports and regularly
  evaluates their performance in support of organizational objectives.
• Performs other duties as assigned.

Supervisory/Management Responsibilities

• Job has direct and/or indirect supervision of team members that may include final budget authority, hire/termination authority, performance appraisal responsibility and disciplinary authority. Job will be considered a member of management staff at Prisma Health or affiliate and will have two or more direct reports.

Minimum Requirements

• Education – Master’s Degree in Accounting, Finance, Business, or related field of study
• Experience – 8 years of payor contracting or healthcare finance. Five (5) years of management experience.

In Lieu Of

• In lieu of a Master’s degree, a Bachelor’s degree and ten (10) years of relevant experience.

Required Certifications, Registrations, Licenses

• NA

Knowledge, Skills and Abilities

• Knowledge of office equipment (fax/copier)
• Proficient computer skills (word processing ,spreadsheets, database)

Work Shift

Day (United States of America)

Location

Prisma Health Corporate Office

Facility

7001 Corporate

Department

70019069 Managed Care Contracting

Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.