Payer Engagement Director

Job Description

Today, SCA Health has grown to 11,000 teammates who care for 1 million patients each year and support physician specialists holistically in many aspects of patient care. Together, our teammates create value in specialty care by aligning physicians, health plans and health systems around a common goal: delivering on the quadruple aim of high-quality outcomes and a better experience for patients and providers, all at a lower total cost of care.

As part of Optum, we participate in an integrated care delivery system that enables us to support our partners as they navigate a complex healthcare environment, Only SCA Health has a dynamic group of physician-driven, specialty care businesses that allows us to customize solutions, no matter the need or challenge:

• We connect patients to physicians in new and differentiated ways as part of Optum and with our new Specialty Management Solutions business.
• We have pioneered a physician-led, multi-site model of practice solutions that restores physician agency by aligning incentives to support growth and transition to value-based care.
• We lead the industry in value-based payment solutions through our Global 1 bundled payment convener, that provides easy predictable billing to patients.
• We help physicians address everything beyond surgical procedures, including anesthesia and ancillary service lines.

The new SCA Health represents who we are today and where we are going—and the growing career opportunities for YOU.

SCA Health is seeking a Director of Payer Diligence who will be fully dedicated to SCAH's acquisition pipeline, responsible for completing the simultaneous payer and managed care based diligence of multiple ASC, Surgical Hospital, and Specialty Practice transactions of varying size and complexity. The Director of Payer Diligence will work closely with Payer Engagement, Payer Analytics, Operations, Corporate Development, and Diligence & Integration teammates to understand the payer and managed care dynamics of acquisitions in support of successful integration. Director of Payer Diligence is expected to work independently, leading multiple and complex projects while ensuring process standardization and scalability. The Director of Payer Diligence should be able to intersect payer strategy with analytics to identify M&A related risks and opportunities on acquisitions.

Duties & Responsibilities

• Perform required work in a self-directed manner, meeting all timelines and due dates

• Complete payer managed care contract reviews and risk assessments

• Establish payer value proposition and align deal model expectations with payer strategy execution

• Develop and recommend strategic contract initiatives, desirable reimbursement methodologies, and preferable managed care contract language that drive revenue growth in fee for service or value-based models with payers across numerous acquisition opportunities.

• Partner with Payer Analytics to perform and review analytics to evaluate opportunities that will drive or detract from post-acquisition payer strategy and escalate anomalies to leaders and support services as appropriate.

• Possess ability to multi-task more than one complex project at once, ensuring accountability to establish deadlines, timelines, and tasks.

• Proactively problem solve by identifying project variances, barriers, or gaps in the diligence process and work with support service teammates to resolve in a manner that keeps transaction moving forward

• Work cross-functionally to align payer strategy and expectations across numerous stakeholders, including teammates who will be responsible for executing on the payer strategy commitments

• Drive Process Improvement: In the spirit of continuous improvement, partner with diligence and non-diligence stakeholder to understand and improve existing processes and tools, including project plans dashboards and the scope and detail of diligence review for all types of provider acquisitions.

• Partner with counsel and other support services lanes on non-standard transactions to ensure appropriate risk assessment is completed

Skills

• Excellent interpersonal skills including a proven ability to successfully interact and foster open dialogue with senior executives, Corporate Development, Operations and Payer Team.

• Exceptional analytical, organizational, and problem-solving skills with demonstrated ability to achieve results in a fast-paced, dynamic, ever-changing environment.

• Ability to role model SCA Health’s Mission, Vision and Values.

• Possess high integrity, professionalism, optimism, and energy

• Ability to quickly establish credibility and organizational relationships while building consensus.

• Detailed understanding of payer landscape, reimbursement methodologies, and payer contractual language terms

• Creative, accountable, and solution-oriented to identify go forward strategies in the support of organizational growth strategies.

Qualifications

• Bachelor’s degree required

• 7+ years relevant work experience: Diligence, health plan contracting/healthcare operational/consulting experience, project management

• Strong analytical skills, along with expert in Microsoft products required

• Excellent communication skills, verbal and written

• Advanced knowledge of managed care related activities including: negotiations, legal, regulatory, operational, finance, and relationship management.

• Demonstrated success in supporting competing, complex projects and interfacing with matrixed teams

• Good general business acumen; capable to analyze complex business problems and provide solutions

• Travel required – 5-10%

USD $122,100.00/Yr. USD $160,000.00/Yr.

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