Ardent Health Services is a leading provider of healthcare in communities across the country. Through its subsidiaries, Ardent owns and operates nearly 200 sites of care and 30 hospitals across six states. Together, our 24,000 employees and 1,200 employed providers touch more than 10,000 lives each day. With six Ardent entities earning recognition on Modern Healthcare's Best Places to Work list in 2022, Ardent and its facilities continue to earn recognition for outstanding workplace cultures where team members feel a sense of belonging and have opportunities to grow their careers. Ardent has also been recognized by Comparably's Best Places to Work Awards, earning honors in the Best CEO, Best Company for Women, Best Leadership Teams and Best Work Life Balance categories among others.

POSITION SUMMARY

Reporting to the Director, Payer Contracts, the Manager, Payer Contracts will serve as a liaison to health plans on behalf of Ardent Health and will participate in the renegotiation of professional and value-based care programs, which includes episodic-based payments, and alternative service delivery models and payment. The Manager will assist the leadership team in managing joint operating committees with health plan payers which includes financial reconciliation and true-ups, clinical case reviews, and networking and marketing opportunities. This role will also negotiate new product contracts and monitor the growth of these products versus budget. The Manager will have a strong focus on resolving claims issues and decreasing the administrative burden of working with managed care organizations.

• Assists in managing health plan contracts and ensures terms and rates are aligned with the strategic goals and objectives of Ardent Health pertaining to revenue and yield. Renegotiates contracts, in conjunction with leadership, as needed.
• Manages relationships with health plans on behalf of the enterprise by maintaining regular contact with key leaders at each health plan.
• Participates in strategic meetings with key hospital, ACO/IPA provider organizations focused on developing value/risk-based partnerships.
• Evaluates business processes and identifies issues/areas of opportunity; collaborates with internal departments (Finance, Legal, Operations, Business Development, Managed Care Services Unit, Revenue Cycle, etc.) and external health plan payers to improve/modify business processes.
• Assists in negotiating new rates and value-based relationships with health plans based on financial modeling.
• Participates in joint operating committees with health plan payers to reconcile value-based payments and incentives/penalties with performance reporting related to quality, customers, expenses, and total cost of care when applicable.
• Collaborates with appropriate internal departments to resolve or challenge health plan payer denials to maximize reimbursement.
• Identifies and evaluates issues and opportunities related to health plan business processes; makes recommendations for improvements and leads implementation of changes.
• Liaises with internal partners to facilitate single case agreements with non-contracted health plans such as rate negotiation, securing an authorization, and/or arranging for any special handling that might be required with AHS internal departments.
• Monitors the health plan industry for emerging/changing trends and provides proactive recommendations for Ardent Health to adapt to the ever-changing industry.
• Performs all duties inherent in a managerial role: ensures effective staff training, evaluates staff performance, provides input for the development of the department budget, and hires, promotes, terminates staff, and recommends salary actions as appropriate.
• Participates in special projects and negotiates contracts as assigned.

Education and Experience:

• Bachelor's degree, required; Master's degree in related field, preferred
• 5+ years of experience negotiating and managing contracts required, preferably in healthcare
• 3+ years of supervisory experience, preferably in healthcare
• Experience in large, multi-facility organization, preferred
• Multi-state experience, preferred
• Previous experience with an insurance provider, preferred

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