Manager of Payer Contracting (International Programs) - Full Time, Days

Join UChicago Medicine, as a Payer Contracting Manager for our International Programs as a part of our Managed Care department. Here you will focus on international contracting with international companies, third party administrators, and embassies supporting robust international business needs to include Transplant cases. This position will be primarily a work from home opportunity with the requirement to come onsite to our Hyde Park and Burr Ridge campuses as needed. You may be based outside of the greater Chicagoland area.

As a Payer Contracting Manager you will be responsible for developing and maintaining relationships with third party payers including but not limited to Managed Care Commercial payers, Direct-To-Employer, International payers, Medicare Advantage payers and Medicaid payers and negotiating fee-for-service (FFS) managed care agreements with these payers on behalf of UChicago Medicine (UCM) system hospitals, physicians and ambulatory/ancillary providers. Under the supervision of the Director of Payer Contracting, oversee all aspects of the UCM managed care FFS contracting portfolio and process including negotiation of contract language, financial reimbursement and operational terms and overall relationship management with the payers with the goal of helping our providers grow and maximize financial performance. Partner with other Office of Managed Care and UCM team members to ensure successful contract negotiation and implementation, monitoring and enforcement of contract terms and support for value base care contracting initiatives. Focus on collaboration and transparency with all key stakeholders within UCMC, IMH, BSD, Care Network, service lines and operations, and physician and hospital revenue cycle teams to develop and execute payer contract strategies. Serves as internal resource to assist UCM hospitals and physicians with payer contract, reimbursement and compliance issues and concerns.

Essential Functions and Responsibilities

• Under the Leadership of the VP Payer Contracting and Strategy and the Director of Payer Contracting, manage the full contract negotiation/re-negotiation cycle from assessment and identification of contract opportunities through implementation of the contract; negotiating and managing complex and innovative FFS payer contracts striving to maximize revenue and maintain competitive reimbursement rates.
• Develop and maintain relationships with the payers as the primary contracting lead for the UCM system and serve as a resource for the other OMC Directors to manage payer interactions from a contracting, value based care, operations and provider relations standpoint.
• Support and facilitate governance of payer contracting activities, acting as a managed care contract and insurance knowledge resource across the UCM system. Works collaboratively and cross-functionally with all UCM entities to support and facilitate key OMC meetings including Contracts Committee, as well as, participates in and coordinates periodic meetings with internal UCM key internal stakeholders (e.g., BSD and Office of Physician Clinical Practice, revenue cycle, Strategic Planning, Finance/Decision Support, etc.) to share critical information regarding managed care contract updates and market trends.
• Work closely with the Finance and Contract Analytics team to analyze, model and negotiate all FFS contracts (current and proposed) for UCM hospitals, physicians and ambulatory/ancillary providers and develop robust financial business analytics to monitor and manage the expected payment and financial margins for the managed care business with the goal of revenue optimization.
• Working with UCM legal counsel, review, redline and negotiate FFS contract language for all Managed Care Commercial payers, Direct-To-Employer, International payers, Medicare Advantage payers and Medicaid payers.
• Assists in the creation and provides support in the execution of a comprehensive payer contracting strategy.
• Work closely with the Provider and Payer Relations team to assist in contract implementation and provider education regarding all managed care FFS contracts and support the resolution of escalated payment/administrative compliance issues with the payers. Attend payer joint operating committees (JOCs) as needed.

Required Qualifications 

• A Bachelor’s degree from an accredited school or university
• A minimum of five years of progressive experience leading provider and payer contract negotiations for hospitals and physicians
• Experience in multi-facility health system, large academic and community physician groups or clinically integrated network, large academic medical center or insurer environment
• Detailed knowledge of hospital and physician complex reimbursement methodologies including FFS and value based care (VBC) risk reimbursement structures including Medicare and Medicaid terms
• Excellent understanding of contract language and rate terms, physician and hospital coding and billing, claims forms and claim payment methodologies, payer EOBs, and insurance laws
• Excellent analytical and problem solving skills, and the ability to make decisions quickly and independently
• Strong written and verbal communication skills with ability to communicate effectively and motivate others
• Strong attention to detail and well organized
• Strong ability to network internally and externally to build relationships, facilitate discussion and resolution
• Ability to work on multiple projects simultaneously
• Ability to maintain a strong connection to internal partners and external payers with relationship management and overall communication approach
• Advanced proficiency with the Microsoft Office Suite, particularly Word (redlining and compare), Excel and PowerPoint

Preferred Qualifications

• MBA or Master’s Degree in Health Care Administration
• Direct experience negotiating contracts with international partners and working with international care delivery models
• Knowledge of and experience with key players in international insurance (BUPA, Allianz, MetLife, Now Health, MSH, MGEN, AXA Global, etc.)
• Knowledge of transplant contract considerations (e.g. stages of transplant care for various transplant types, services such as pre surgical testing, collection, organ procurement, etc. as parts of each transplant), and various reimbursement methods that cover such complex cases
• Extensive familiarity with the Illinois provider and payer market and competitive landscape and demonstrated experience and success in building and maintaining positive relationships with payer partners
• Experience with governmental programs related to Medicare, Medicaid managed care and Medicare Advantage highly desirable
• Experience utilizing contract management/modeling systems (e.g., FinThrive, MedAssets, etc.) highly preferred

Position Details

• Job Type/FTE: Full Time (1.0); 8-hour shifts
• Shift: Days - Mondays to Fridays
• Office Location: Flexible Remote - occasional travel to Burr Ridge & Hyde Park campuses
• Unit/Department: Managed Care
• CBA Code: Non-Union

We’ve been at the forefront of medicine since 1899. We provide superior healthcare with compassion, always mindful that each patient is a person, an individual. To accomplish this, we need employees with passion, talent and commitment… with patients and with each other. We’re in this together: working to advance medical innovation, serve the health needs of the community, and move our collective knowledge forward. If you’d like to add enriching human life to your profile, UChicago Medicine is for you. Here at the forefront, we’re doing work that really matters. Join us. Bring your passion.

UChicago Medicine is growing; discover how you can be a part of this pursuit of excellence at: UChicago Medicine Career Opportunities.

UChicago Medicine is an equal opportunity employer.  We evaluate qualified applicants without regard to race, color, ethnicity, ancestry, sex, sexual orientation, gender identity, marital status, civil union status, parental status, religion, national origin, age, disability, veteran status and other legally protected characteristics.

Must comply with UChicago Medicine’s COVID-19 Vaccination requirement as a condition of employment. If you have already received the vaccination, you must provide proof as part of the pre-employment process. This is in addition to your compliance with the Flu Vaccination requirement as well. Medical and religious exemptions will be considered consistent with applicable law. Lastly, a pre-employment physical, drug screening, and background check are also required for all employees prior to hire.

Compensation & Benefits Overview

UChicago Medicine is committed to transparency in compensation and benefits.  The pay range provided reflects the anticipated wage or salary reasonably expected to be offered for the position.

The pay range is based on a full-time equivalent (1.0 FTE) and is reflective of current market data, reviewed on an annual basis. Compensation offered at the time of hire will vary based on candidate qualifications and experience and organizational considerations, such as internal equity. Pay ranges for employees subject to Collective Bargaining Agreements are negotiated by the medical center and their respective union.

Review the full complement of benefit options for eligible roles at Benefits - UChicago Medicine.