Director of Insurance Contracting & Relations

Position Summary:

The Director of Insurance Contracting & Relations is responsible for a variety of activities that enhance health plan and payer contracting of RWHC Network members, assist in contract and payment issues, and inform advocacy efforts of RWHC. This position serves as a key member of the Senior Staff Team (SST). This position is highly visible inside and outside the organization therefore requiring a high level of professionalism to develop and maintain credibility across the healthcare industry. Please email resumes to office@rwhc.com.

Specific Responsibilities:

1) Establish, improve and maintain provider and payer relationships

2) Manage activities of RWHC Network (commercial contracts and payers):

a) Review & negotiate RWHC approved language templates for participating provider agreements submitted by members or payers.

b) Assist members in review of individual components of contracts as requested

c) Negotiate non-financial contract terms with receptive health plans

d) Assist members with operational and administrative issues including but not limited to claims payment issues, denials, prior authorizations, policy changes, etc.

e) Meet with health plan representatives as needed to advise of issues of specific importance to members and resolve contract issues

f) Educate members on payer trends and payer specific issues

g) Educate members regarding general contracting practices

h) Answer member inquiries about health plans

i) Prepare agenda and facilitate periodic Network meetings (3-4 x per year) including scheduling of guest presenters from payers, CMS, Quarles, etc.

3) Manage activities of RWHC LLC (Governmental Plans including Medicare and Medicaid):

a) Prepare agendas and facilitate annual meeting for RWHC LLC

b) Negotiate contract terms within parameters of LLC agreement and members of opt-in opportunities

c) Advise health plans regarding specific issues of importance to members

d) Educate members and respond to inquiries regarding Medicare Advantage offerings and issues

4) Manage activities of Rural Contract Consulting Services, LLC (“RCC”)

a) Assist RCC clients in developing contracting strategy and executing said strategies as directed by the client

b) Review and execute Non-Disclosure agreements as necessary

c) Serve as primary contact in negotiation of both language and economic terms of agreements

d) Adhere to strict confidentiality and protecting of competitively sensitive information to avoid any anti-trust issues

e) Track billable hours of service provided to each RCC client and prepare quarterly invoices for billing of services

5) Participate in RWHC Board meetings

6) Participate in SST management and All-Staff meetings.

7) Gather and disseminate intelligence on payer dynamics, clinically integrated networks, class actions, and other related payer/managed care trends

8) Serve as a liaison with Quarles to support members with legal review and guidance. Review invoices from Quarles for legal services rendered to RWHC Network, LLC or RCC for approval to pay

9) Collaborate with WHA and participate in applicable committees or workgroups

10) Participate in RWHC Maternity Service Work Group and provide input on reimbursement and other payer related aspects

11) If funded, lead HRSA or Rural Health Transformation Program grant work supporting improved insurer relationships with rural hospitals.

General Responsibilities

§ Ability to work as a team member and serve as a team leader.

§ Demonstrate creative problem-solving skills.

§ Ability to coordinate multiple projects and deadlines and balance meeting the varying needs of multiple constituents.

§ Be able to analyze many variables and recommend the most effective course of action for each organization at any given point in time. Must be able to assess possible business and legal ramifications of recommendations.

§ Be able to communicate and provide verbal and written feedback effectively and in a professional manner.

§ Be mentally adaptable and flexible in dealing with a variety of people and situations.

§ Relate and interact with people at all levels in different organizations.

§ Complete RWHC internal education, training and reporting requirements.

Physical Demands:

§ Requires corrected vision and hearing to functional range.

§ Requires working under stressful conditions or working irregular hours.

§ Requires ability to sit or stand for periods of time.

§ Requires manual finger dexterity and eye-hand coordination.

§ Must possess personal vehicle for reimbursable travel and possess or be eligible for a valid Wisconsin Driver's license.

§ Must be able to function in an office setting with background noise and distractions.

§ Ability to travel to various locations for meetings and to visit payers, hospitals, clinics and other facilities.

Equipment to Be Used:

Must be able to operate computer and other office machines such as calculator, telephone, etc.

Education/Experience Requirements:

Experience Five to ten years of progressive health care financial consulting or management experience. Prefer experience with hospitals, physician practice operations, program development and managed care issues. Candidate should have:

§ Effective consultation skills, including ability to analyze and resolve problems.

§ Demonstrated sensitivity to rural healthcare issues.

§ Strong financial skills, including healthcare finance and managed care contracting.

§ Working knowledge of and experience with healthcare networks.

§ Exceptional communication skills (written and verbal).

§ Demonstrated ability to work with a board of directors.

Working Conditions:

Occasionally called upon to work extra time or odd schedules. Works in a typical office setting also has the ability to work remotely at times. Travel to work with RWHC Members and strategic partners will be necessary. RWHC is an equal opportunity employer.