Director, Contract & Provider Services

Be inspired. Be valued. Belong.

At Emory Healthcare we fuel your professional journey with better benefits, valuable resources, ongoing mentorship and leadership programs for all types of jobs, and a supportive environment that enables you to reach new heights in your career and be what you want to be. We provide:

• Comprehensive health benefits that start day 1
• Student Loan Repayment Assistance & Reimbursement Programs
• Family-focused benefits
• Wellness incentives
• Ongoing mentorship, development, leadership programs...and more

Overview:

• The Director/Corporate Director of Managed Care Contracting & Provider Services supports the Vice President of Contracting & Provider Services in the development and execution of enterprise managed care strategies across Emory Healthcare.
• As a key strategic and operational leader for the department, this role advances organizational priorities through cross-functional collaboration, complex problem solving, and execution of enterprise initiatives, driving results through influence, expertise, and collaboration across a highly matrixed healthcare environment.
• The role is responsible for managed care contracting, payer relations, reimbursement strategy, payer dispute resolution, and operational initiatives that support system performance, growth, market competitiveness, patient access, contract performance, and margin improvement across all Emory Healthcare entities.

Primary Duties and Responsibilities:

• Strategic Leadership & Executive Support
  • • 1. Supports the Vice President of Contracting & Provider Services in development and execution of departmental strategies, operational priorities, and organizational initiatives.
    • 2. Serves as a senior departmental leader and trusted delegate to the Vice President, representing departmental priorities and supporting decision-making in the Vice President's absence or as delegated.
    • 3. Works closely with organizational leadership to develop managed care strategies and leads implementation of departmental initiatives that advance organizational growth, market competitiveness, patient access, contract performance, and margin improvement.
    • 4. Represents the department in executive meetings, payer negotiations, governance committees, and other strategic initiatives as delegated.
• Managed Care Contracting & Negotiation
  • • 1. Leads negotiation and management of complex managed care agreements, which include, but are not limited to, Commercial, Medicare Advantage, Medicaid, value-based, employer-sponsored, and alternative reimbursement arrangements.
    • 2. Leads the negotiation, implementation, administration, and optimization of managed care agreements across all Emory Healthcare entities, including hospitals, employed physician practices, the clinically integrated network, ambulatory surgery centers, joint ventures, and affiliated provider networks.
    • 3. Guides execution of complex payer initiatives and promotes consistency in strategic decision-making and contracting practices across the organization.
• Reimbursement & Financial Strategy
  • • 1. Develops and executes payor and reimbursement strategies that support Emory Healthcare's financial and strategic objectives.
    • 2. Identifies opportunities to improve reimbursement, contract performance, revenue outcomes, and payer relationships.
    • 3. Leads financial dispute strategy and operational initiatives that support system performance and financial objectives.
• Payer Relations & Dispute Resolution
  • • 1. Serves as a senior liaison and representative between Emory Healthcare entities and payer organizations and external stakeholders.
    • 2. Leads efforts to resolve complex contractual, operational, reimbursement, and financial disputes with payers.
• Strategic Growth & Business Development
  • • 1. Supports acquisition, affiliation, network expansion, Centers of Excellence, direct-to-employer contracts, and other strategic growth initiatives.
• Cross-Functional Collaboration
  • • 1. Partners with Finance, Revenue Cycle, Legal, Compliance, Population Health, Strategy, Business Development, Operations, and Physician Leadership to advance organizational objectives.
    • 2. Collaborates with operational, financial, clinical, and executive leaders to advance enterprise objectives and maximize contract performance.
• Team Leadership & Development
  • • 1. Provides strategic leadership across the Managed Care department as a mentor, advisor, and resource to the team.
    • 2. Fosters collaboration, knowledge sharing, innovation, and professional development in support of departmental and organizational objectives.
• Additional Duties as Assigned.

Travel: Less than 10% required

Work Type: Hybrid position- splits time working remotely and working onsite

Minimum Required Qualifications:

• Education:
  • Bachelor's degree in Business Administration, Healthcare Administration, Finance, Public Health, or related field required.
• Experience:
  • 7 years of progressive professional experience within an academic medical center, integrated health system, multi-hospital health system, managed care organization, or related healthcare environment, with a least five years directly focused on managed care contracting.
  • Demonstrated experience in healthcare analytics, managed care contracting, payer relations, reimbursement strategy, and financial analysis.
  • Direct experience leading the negotiation, implementation, and management of complex managed care agreements.
  • Strong negotiation and relationship-building capabilities.
  • Demonstrated strategic thinking, business and financial expertise, and the ability to identify and solve complex organizational challenges.
  • Proven ability to lead initiatives through collaboration and influence across diverse stakeholders and operational areas.

• Knowledge, skills, and abilities (required):
  • 1. Expert knowledge of managed care contracting, reimbursement methodologies, payer-provider relationships, and healthcare finance.
  • 2. Strong understanding of commercial, Medicare Advantage, Medicaid, value-based reimbursement models, and alternative payment arrangements.
  • 3. Exceptional communication, presentation, negotiation, and relationship-management skills.
  • 4. Strong analytical, organizational, and problem-solving abilities.
  • 5. Ability to lead through influence in a highly matrixed healthcare environment.

Preferred Qualifications:

• • Education: Master's degree Experience: 10+ years of experience

PHYSICAL REQUIREMENTS (Medium Max 25lbs): up to 25 lbs., 0-33% of the work day (occasionally) Lifting 25 lbs. max; Carrying of objects up to 25 lbs.; Occasional to frequent standing & walking, Occasional sitting, Close eye work (computers, typing, reading, writing), Physical demands may vary depending on assigned work area and work tasks.

ENVIRONMENTAL FACTORS: Factors affecting environmental conditions may vary depending on the assigned work area and tasks. Environmental exposures include but are not limited to: Blood-borne pathogen exposure, Bio-hazardous waste chemicals/gases/fumes/vapors, Communicable diseases, Electrical shock, Floor Surfaces, Hot/Cold Temperatures, Indoor/Outdoor conditions, Latex, Lighting, Patient care/handling injuries, Radiation, Shift work, Travel may be required. Use of personal protective equipment, including respirators, environmental conditions may vary depending on assigned work area and work tasks.