Organization:

SHSO-Sutter Health System Office-Valley

Position Overview:

The position is responsible for participating in the negotiations for payer agreements for commercial and government sponsored products as assigned for Sutter hospital, professional and ancillary providers. The primary focus of this position is to support or lead payer negotiations, implementation of the managed care payer agreements and contract compliance, including performance analysis and recommendations for modifications. Additionally, assures the success of contract performance and works through any contract or claims disputes as well as support dispute litigation.

This is a work from home position with some onsite work as well.

Job Description:

EDUCATION:
Equivalent experience will be accepted in lieu of the required degree or diploma.

• Bachelor's: Healthcare Administration, Business Administration or related healthcare field or equivalent education/experience

TYPICAL EXPERIENCE:

• 8 years recent relevant experience

SKILLS AND KNOWLEDGE:

• Strong Knowledge of market imperatives, provider payment terms and trends for healthcare providers.
• Ability to perform managed care contract analysis, draft language, document review, and work with Sutter operational teams and Payer representatives to support contract compliance.
• Advanced knowledge of the operational implications of managed care contracts relative to both medical groups, ancillary providers and hospitals for all types of Payer products, commercial and government sponsored.
• An understanding of all regulatory requirements for contracting and compliance as it relates to Knox-Keene, Department of Managed Health Care, Department of Insurance, Medi-Cal, CMS, HIPAA or ERISA.
• Ability to influence and facilitate work teams to ensure the effective management of complex, multi-faceted issues, including leading operational meetings with assigned Payer representatives on behalf of Sutter.
• Skills with PowerPoint and Word.
• Ability to build consensus through effective communication skills both written and oral.
• Strong organizational skills.
• Strong knowledge of all types of provider reimbursement, including value based payments.
• Must be able to enlist cooperation and commitment to carrying out initiatives related to contract compliance or operational implementation.
• Must have the ability to maintain a high level of energy as well as the ability to work independently, prioritize multiple objectives and tasks in a rapidly changing environment and deliver quality outcomes.

The salary range for this role may vary above or below the posted range as determined by location. This range has not been adjusted for any specific geographic differential applicable by area where the position may be filled. Compensation takes into account several factors including but not limited to a candidate’s experience, education, skills, licensure and certifications, department equity, training and organizational needs. Base pay is just one piece of the total rewards program offered by Sutter Health. Eligible roles also qualify for a comprehensive benefits package.

Job Shift:

Days

Schedule:

Full Time

Shift Hours:

8

Days of the Week:

Friday, Monday, Thursday, Tuesday, Wednesday

Weekend Requirements:

None

Benefits:

Yes

Unions:

No

This position is work from home eligible.

Position Status:

Exempt

Weekly Hours:

40

Employee Status:

Regular

Number of Openings:

1

Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.