The Role
Lead managed care contracting strategy and negotiations, draft and manage payer/provider contracts (risk-based, FFS, ACOs), evaluate reimbursement and financial performance, develop contract analytics/tools, ensure enterprise contracting consistency, resolve payer/provider issues, and manage ad-hoc projects.
Summary Generated by Built In
Job Title: Senior Director – Payer Contracting
Department: Contracting
About the Role:
We are currently seeking a highly motivated Senior Director – Payer Contracting. This is a hybrid role where the expectation is to work both in office 2 to 3 days in Orange, CA and Monterey Park, CA and at home on a weekly basis. This role will work closely with the SVP of Payer Contracting to develop and execute on managed care contracting strategies and negotiations. You will be responsible for identifying and evaluating payor and provider opportunities, determining optimal reimbursement rates, drafting and managing contracts, serving as an organizational subject matter expert on existing capitation and fee for service agreements for Multi-State Market and other states, and researching and resolving payor and provider issues.
Department: Contracting
About the Role:
We are currently seeking a highly motivated Senior Director – Payer Contracting. This is a hybrid role where the expectation is to work both in office 2 to 3 days in Orange, CA and Monterey Park, CA and at home on a weekly basis. This role will work closely with the SVP of Payer Contracting to develop and execute on managed care contracting strategies and negotiations. You will be responsible for identifying and evaluating payor and provider opportunities, determining optimal reimbursement rates, drafting and managing contracts, serving as an organizational subject matter expert on existing capitation and fee for service agreements for Multi-State Market and other states, and researching and resolving payor and provider issues.
What You'll Do
- Leads contract negotiations, as assigned, including risk-based agreements, fee-for-service negotiations, pay for performance programs, and ACO agreements with health plans
- Manages contractual relationships with payers and internal stakeholders
- Reviews health plan contract language and is familiar with payor, medical group/IPA, and hospital/ancillary contract language and reimbursement mechanisms
- Circulates draft contract terms/language to various internal departments for review & approval
- Applies knowledge of healthcare delivery system, IPA operations, managed care, healthcare laws in assisting with the development of contracting strategies
- Answers and/or resolves inquiries from health plans or internal departments in a timely manner
- Establishes good working relationships with health plan representatives and internal teams
- Develops tools (e.g., dashboards, grids, tables, summaries) to provide organizational leadership key contract data
- Utilizes applicable financial tools and reports to evaluate performance of current contracts
- Interacts and consults with Network Pricing team to evaluate different financial arrangements and recommend applicable payment methodologies
- Ensures compliance and consistent contracting across the enterprise.
- Manages various ad-hoc project requests with short turnaround time.
- Performs other duties as assigned.
Qualifications
- Master’s degree and/or Bachelor’s degree or BS/BA in business administration or health care related field of study or equivalent years of experience
- Direct experience leading health plan/provider negotiations
- Experience with financial models analyzing health plan agreements
- At least 10 years prior experience in contracting
You're great for this role if:
- Experience in risk-based contracting and associated financial analysis strongly preferred
- Ability to close deals under tight deadlines-sense of urgency
- Comfortable in negotiating all types contracts from start to finish within defined parameters
- Experience with FFS, capitation, and risk sharing arrangements
- Experience with government programs (Medicare, Medi-Cal, D-SNP)
- Experience working with health plan, provider and hospital counterparts
- Knowledge of California payer, Institutional and IPA contracting
- Successful experience negotiating contracts for all Lines of Business (Commercial, Medicare, Medicaid, and Accountable Care)
- Project management skills/experience
- Advanced MS Word capabilities: find & replace, redlining, comment insertion, track changes and document compare
- Proficient in MS Excel (including use of functions and pivot tables) and PowerPoint software
- Demonstrated ability to work with effectively with multiple different areas within an organization (both internal and external)
- Proven ability to work effectively both independently and with teams in a dynamic and fast paced environment
- Proven leadership/strategy and organizational skills are required, as well as excellent written and verbal communication skills
- Strong interpersonal and communication skills and ability to work effectively with a wide range of constituencies
- Experience with healthcare operations, systems, and financial/claims data analysis
Environmental Job Requirements and Working Conditions
- Our organization follows a hybrid work structure where the expectation is to work both in office and at home on a weekly basis. The office is located at 1600 Corporate Center Dr. Monterey Park, CA 91754 and 600 City Parkway West, Orange, CA 92868.
- The annual total compensation target pay range for this role is: $175,000 - $185,000. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.
Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at [email protected] to request an accommodation.
Additional Information:
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.
About
Astrana Health (NASDAQ: ASTH) is a physician-centric, technology-powered healthcare management company. We are building and operating a novel, integrated, value-based healthcare delivery platform to empower our physicians to provide the highest quality of end-to-end care for their patients in a cost-effective manner. Our mission is to combine our clinical experience, best-in-class delivery network, and technological expertise to improve patient outcomes, increase access to healthcare, and make the US healthcare system more efficient. Our platform currently empowers over 20,000 physicians to provide care for over 1.7 million patients nationwide. Our rapid growth and unique position at the intersection of all major healthcare stakeholders (payer, provider, and patient) gives us an unparalleled opportunity to combine clinical and technological expertise to improve patient outcomes, increase access to quality healthcare, and reduce the waste in the US healthcare system.
Skills Required
- Master's degree and/or Bachelor's degree in business administration or health care related field, or equivalent experience
- Direct experience leading health plan and provider negotiations
- Experience with financial models analyzing health plan agreements
- At least 10 years prior experience in contracting
- Comfortable negotiating all types of contracts from start to finish
- Advanced MS Word capabilities (find & replace, redlining, track changes, document compare)
- Proficient in MS Excel (functions, pivot tables) and PowerPoint
- Experience in risk-based contracting and associated financial analysis
- Experience with fee-for-service, capitation, and risk-sharing arrangements
- Experience with government programs (Medicare, Medi-Cal, D-SNP)
- Project management skills/experience
- Knowledge of California payer, institutional and IPA contracting
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The Company
What We Do
Astrana Health is a physician-centric, technology-powered healthcare company that operates an integrated delivery platform. It enables providers to participate in value-based care arrangements, helping them deliver accessible, high-quality, and cost-effective care to patients. The company provides care coordination services to patients, primary care physicians, specialists, and health plans, leveraging proprietary technology to streamline operations and improve patient outcomes across local communities.
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