1. Integrates and aligns payer strategy with Vail Health?s strategic objectives, including population health strategies, value-based contracting strategies, contract management, operations processes, and government reimbursement trends.
2. Maximizes operational standards related to third party payment and facilitates enhanced access to the organization for members of the community.
3. Reviews and negotiates payment terms based on multiple reimbursement models, including fee-for-service payment terms, valued based payments and gain/risk sharing arrangements
4. Responsible for contract rates aligned with each CPT code table maintenance within the Surgery Center practice management software.
5. Includes integration (relative to payer strategy) across key functional areas of Revenue Cycle Management, Finance, Decision Support, Legal, Reimbursement, and Business Development]
6. Leads key payer negotiations with the goals of maintaining adequate operating margins, growing the payer portfolio and advancing value-based pricing logic.
7. Ensures contract language aligns with all State and Federal laws/regulations and organizational policies.
8. Ensures contract language includes all appropriate wording to protect Vail Health from capricious changes that adversely impact reimbursement levels or timely payment.
9. Communicates and provides tools for contractual terms to other departments whose functions are necessary to the development, implementation and management of the provider arrangements .
10. Maintains knowledge and understanding of healthcare industry trends, standards, and current events relative to provider contracting, network administration and market.
11. Role models the principles of a Just Culture and Organizational Values.
12. Performs other duties as assigned. Must be HIPAA compliant.

• 5 years leadership experience in connection with managed care contracting and payer relations in a similar environment.
• Demonstrated ability in financial analysis, payment methodologies, contract language, negotiation strategy/tactics, relevant regulatory and compliance issues.

Preferred:

• HST Pathways Practice Management
• Waystar clearinghouse optimized workflow

• N/A

• Healthcare Financial Management Association CRCR preferred

• Must possess, or be able to obtain within 90 days, the computer skills necessary to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.

• Bachelor?s degree in finance, business administration, healthcare management, or a related field. Master?s degree preferred.

Benefits at Vail Health (Full Time) Include:

• Competitive Wages & Family Benefits:
  • Competitive wages
  • Parental leave (4 weeks paid)
  • Housing programs
  • Childcare reimbursement 
• Comprehensive Health Benefits: 
  • Medical
  • Dental 
  • Vision
• Educational Programs: 
  • Tuition Assistance 
  • Existing Student Loan Repayment
  • Specialty Certification Reimbursement
  • Annual Supplemental Educational Funds
• Paid Time Off:
  • Up to five weeks in your first year of employment and continues to grow each year.
• Retirement & Supplemental Insurance:
  • 403(b) Retirement plan with immediate matching 
  • Life insurance
  • Short and long-term disability
• Recreation Benefits, Wellness & More:
  • Up to $1,000 annual wellbeing reimbursement
  • Recreation discounts
  • Pet insurance

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About Vail Health

Vail Health, formerly Vail Valley Medical Center, is a nonprofit community health care system serving patients and guests from around the world. Locally operated and governed by a volunteer board of directors, Vail Health includes a 56-bed hospital, accredited by the Joint Commission. Our 24/7 emergency department in Vail is a Level III Trauma Center with a nearby helipad for necessary medical transports. Vail Health provides a wide array of services and access points including Beaver Creek Medical Center, urgent care clinics in Avon and Gypsum, our Edwards medical campus, Eagle Healthcare Center and a multispecialty clinic in Frisco. Howard Head Sports Medicine offers physical therapy services at 10 locations and works closely with our internationally renowned orthopaedic partners at The Steadman Clinic and Vail-Summit Orthopaedics. In addition, Vail Health's Shaw Cancer Center and Sonnenalp Breast Center are the region’s only fully accredited cancer treatment center and comprehensive breast center. The Vail Clinic, which was founded in 1965, officially became “Vail Valley Medical Center” in 1980, its first year as a full-service hospital. At that time, we had one primary locatio...n and 25 physicians. Today, Vail Health has locations in nine towns, nearly 1,000 employees, 260 physician partners and 85 volunteers. Vail Health is an equal-opportunity employer. The hospital is handicap accessible and adheres to the Americans with Disabilities Act. Smoking is prohibited in our facilities. This includes e-cigarettes.

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