Director Payer Contract/Credentialing (Managed Care Dept) at Nicklaus Children's Health System in Miami, Florida

Job Description:

Job Summary

Responsible for technical and professional payer contracting, credentialing, and pricing for the entire Health System. Provide  guidance and support to Senior Leadership in aspects of payer contracting/negotiations, pricing, and delegated credentialing for the Health System. Responsible for pivoting and adapting NCHS to an everchanging payer landscape and reimbursement structure. Be a role model and leader to subordinates and develop a strong educated and impactful team bench.

Job Specific Duties

• Responsible for detailed understanding of health care industry, market dynamics, trends, competitors, regulations, and payer environment.


• Collaborates with the management team and all departmental levels on both the hospital and physician sides.  Ensure operational issues are addressed and remedied through negotiation, project planning, or contract modification. 


• Creates and maintains professional relationships with payers and potential affiliates. 


• Creates, analyzes, and interprets financial reports to support payer negotiations, trends, and audit.


• Implements and communicates contracting strategies in collaboration with  Senior Leader. 


• Manages all out of network contracting for both hospital and employed physicians. 


• Responsible for the management and development of subordinates. 


• Knowledge and willingness to support new value based transformational contracting strategy at the right time in the right setting. 


• Provides direction, feedback, and recommendations on trended payer performance; serves as the SME for all payer related contractual arrangements/issues- current and historical. 


• Responsible for overseeing the management of all in network and out of network contracting and negotiations for the hospital and employed physician group. 


• Responsible for making high impact decisions steeped in judgment. 


• Develop and lead Joint Operating Committee meeting with payers and respective NCHS departments. 


• Complies with legal and regulatory compliance requirements. 


• Leads and oversees Corporate Pricing function.


• Leads and oversees Corporate Credentialing function.

Minimum Job Requirements

• Bachelor's Degree in Business Administration or Health Management


• 4-7 years of management experience in the healthcare finance/payer/managed care contracting field


• 7-10 years of hospital and/or payer negotiations and analysis experience

Knowledge, Skills, and Abilities

• MBA or MHA preferred.


• Work well under immense pressure with an ability to focus on multiple priorities while maintaining focus, attention to detail, and connecting all the dots.


• Demonstrated leadership progression.


• Knowledge of fee for volume and fee for value reimbursement methods.


• Strong contract review and interpretation skills.


• Familiarity working with Lawyers and interpreting statutes and regulations.


• Business acumen and strong financial skills.


• Excellent written, oral, and communications skills.


• Success in persuasion, influence, and negotiation skills.


• Management expertise, strong knowledge of data analysis, and statistics.


• Able to handle day to day administrative routine, as well as, constantly changing, competing projects,  urgent situations, sometimes simultaneously.


• Able to relate cooperatively and constructively with payers and co-workers.


• Effective communicator with a strong, transparent, and clear style; ability to deliver tough messages with tact.


• Effectively monitor and develop the abilities of subordinates.


• Able to maintain confidentiality of sensitive information.


• Knowledge of payer and hospital credentialing function.


• Ability to interpret, adapt, and react calmly under stressful conditions.


• Ability to analyze and interpret complex models and apply to business ask; strong spreadsheet skills.


• Ability to use logical & scientific thinking to interpret technical data and solve a broad range of problems.


• Able to relate cooperatively and constructively with medical staff, executives, staff, elected officials, and managed care companies.