Job description

Responsibilities

The Sr. Director of Payor Contract Operations develops and maintains Kelsey-Seybold’s and Physician Group of Texas’s (PGT’s) payer strategy in collaboration with the leadership team. The primary purpose of this role is to translate the value of the PGT and Kelsey-Seybold Clinic’s healthcare delivery services and provider networks into effective managed care strategies and contracts and successful relationships with customer stakeholders, including payers/insurers, employers, government sponsors, individual consumers, vendors, and distribution channel partners.

Accountabilities include achieving Kelsey-Seybold and PGT payer strategy objectives, integrating enterprise strategic payer and product initiatives with marketplace strategies and tactics, and partnering with ACO / Clinically Integrated Network (CIN) leadership in designing, contracting, and marketing ACO / CIN networks and services. The Sr. Director of Payer Contract Operations will also direct the facility contracting strategy for commercial lines of business.

The Sr. Director, Payor Strategy is a remote position with up to 25% travel required if the candidate is outside of the greater Houston area.

Minimum Qualification:

Bachelor’s Degree or equivalent experience

Required Experience:

• 10+ years of professional experience within healthcare with a minimum of 5 years of experience in a leadership role that includes, payor contracting and contract administration.
• Experience negotiating global and professional capitated arrangements and/or other incentive risk & reward models
• Experience negotiating commercial and Medicare facility and ancillary agreements
• Demonstrated experience with commercial and government products (Medicare, Medicaid, or Exchange plans)
• Demonstrated ability to develop and interpret summary plan documents, schedule of benefits, contract provisions, division of financial responsibility, and payment methodologies that include valued based incentives, professional capitation, and global risk.
• Highly developed communication and presentation skills. Must be an excellent public speaker
• Expert level healthcare financial acumen.
• Excellent communication/presentation skills with both internal and external audiences. markets
• Advanced understanding of health plan operations with strong exposure to Third Party Administrator (TPA) operations and claims management functions

Preferred Skills and Experience:

• Sound budgeting and financial management skills
• Excellent analytic and financial skills, with a keen understanding of impacts on markets
• Demonstrated ability to work effectively in a matrix-oriented organization and to effectively drive strategic transformation work
• Depth of experience with health plan product design (deductible, tiered/narrow network, HMOs, PPOs, etc.) and pricing strategies
• Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, and percentages. Ability to apply concepts of basic algebra.
• Understanding of provider risk models.
• Ability to lead, motivate and inspire individuals and groups. Experienced in team building and mentoring
• Valid Texas Driver’s License and ability to travel throughout metropolitan Houston
• Group I Insurance License in good standing with TDI is a positive

Job Type: Full-time

Pay: $161,241.00 - $192,570.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Employee discount
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Professional development assistance
• Relocation assistance
• Tuition reimbursement
• Vision insurance

Schedule:

• Monday to Friday

Supplemental pay types:

• Bonus pay
• Signing bonus

Ability to commute/relocate:

• Pearland, TX 77584: Reliably commute or planning to relocate before starting work (Preferred)

Work Location: One location

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