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Position Summary: The Senior Payer Contract Manager is responsible for developing and implementing contracts with third party payers on behalf of MultiCare Health System and its affiliates. This role ensures MultiCare and our affiliates have consistent and well-functioning relationships with payers over time, in alignment with MultiCares vision and strategic priorities. The Manager will lead negotiations with assigned payers to include payment terms based on multiple reimbursement models, including fee-for-service payment terms, value based payment terms, and gain/risk sharing arrangements. The Manager serves as the lead managing the overall payer relationship, makes recommendations to Sr. Leadership on product participation, and will continually evaluate the payer relationship for opportunities to improve revenue, lower the cost of doing business, and to improve MultiCares access to patents. The Manager is accountable for negotiating contract language that aligns with all State and Federal laws and regulations, is consistent across payers, and does not expose MultiCare financial, legal, or operational risk to MultiCare or the payer.The Senior Payer Contract Manager will support the company's business imperatives by leading the reimbursement strategy to support ensuring success in business objectives inclusive of pre-launch activities, collaboration with business development for compilation of a payer dossier and support of ongoing operations to ensure successful execution of public and private payer in-network strategies in laboratory environments for hospital and physician office clients. Manager researches markets to identify and evaluate new contracting opportunities. Develops and grows strategic relationships with payers to positively impact negotiations and secure in-network coverage.Collaborates internally to reply to payer compliance attestation requests, quality reporting, Medicare payer fee schedule requirements, and any additional payer requests by providing required information in accordance with regulatory requirements, payer contract terms, and MultiCare' s policy and procedure.Provides training, updates and collaboration with marketing, business development and leadership relative to contract changes, strategy and landscape changes in supporting market access objectives
Minimum Requirements: Seven or more (7+) years of experience performing financial/medical data/payer mix analysis or contract negotiation in a healthcare environment, health system or health plan; Diagnostic or laboratory payer experience preferred Experience with medical and pricing terminology to include but not limited to DRG, RUG, APC, RVU, Conversion Factors, G codes etc.
Education/Licenses/Certifications: Bachelors degree with a major in finance, Healthcare administration, or related field; or 10+ years experience in Payer Contracting for a Health System or Health Plan as degree equivalent
Position Type: Full-Time Regular Full Time Employee: YesPrimary Shift: Day Work Schedule: Day
MultiCare is a not-for-profit health care organization with more than 20,000 team members, including employees, providers and volunteers. MultiCare has been caring for our community for well over a century, since the founding of Tacoma’s first hospital and today is the largest community-based, locally governed system of health in the state of Washington, serving communities across Washington and Northern Idaho.
MultiCare’s comprehensive system of health includes numerous primary care, urgent care and specialty services — including Mary Bridge Children’s Hospital & Health Network; MultiCare Indigo Urgent Care; Pulse Heart Institute; MultiCare Medical Associates, affiliated physicians; MultiCare Rockwood Clinic, the largest multispecialty clinic in the Inland Northwest region; and MultiCare Connected Care, our Accountable Care Organization.
Eleven hospitals complete the organization: Allenmore Hospital, Auburn Medical Center, Capital Medical Center, Covington Medical Center, Deaconess Hospital, Good Samaritan Hospital, Mary Bridge Children’s Hospital — the Puget Sound region’s only children’s hospital and state-designated Level II Pediatric Trauma Center for Western Washingt...on — Navos Behavioral Health Hospital, Valley Hospital, Tacoma General Hospital — which is home to the South Puget Sound region’s only Level IV Neonatal Intensive Care Unit — and Wellfound Behavioral Health Hospital.
Our core values of Respect, Integrity, Stewardship, Excellence, Collaboration and Kindness, serve as our guiding principles and impact every aspect of our organization, including how we provide patient care and what we expect from each other.
MultiCare is also proud of our commitment to workforce diversity and culturally competent care. This commitment is led by our CEO and supported through employee education and community outreach.