Pennsylvania Mountains Healthcare Alliance (PMHA) is seeking a Director of Contracting and Payer Relations. The position is a key strategic role in the management of PMHA’s Revenue Cycle operations and initiatives across a multi-provider consortium. Key responsibilities include contract negotiations, maintaining positive payer relationships, and ensuring payers’ adherence to contractual obligations with PMHA member facilities. The position reports to the VP of Finance/Revenue Cycle working in partnership with our financial leadership team. Responsibilities include leading a team in collaboration with internal partners for successful execution of client contracts, finalizing all portions of contracts associated with pricing and financial terms, and shaping of a new contract management workflow system. The Director will build a high-performance organization, influence revenue goals, and ensure data quality and ethical practices while upholding PMHA’s service excellence, quality, and safety standards.

Key Responsibilities: 

• Review and negotiate comprehensive contract language for hospitals to reduce risk and improve efficiency 

• Secure optimal reimbursement and protect the interests of PMHA hospitals in contract negotiations 

• Assess legal, financial, and strategic implications of all contracting opportunities

• Develop and maintain standards of pricing strategies, definitions, and performance metrics 

• Maintain productive relationships with payor organizations and our member hospitals

• Maintain accountability for finalizing the pricing and financial terms portions of payer contracts

• Advise member hospitals on matters pertaining to new initiatives related to managed care contracts 

• Implement and maintain a contract management/monitoring tool used for payment management, payor performance, and contract negotiations

• Collaborate with hospital department managers and directors regarding payor audits and denials

• Provide strategic planning accountability for other reimbursement and profitability endeavors in regards to government programs and pay for performance initiatives

The ideal candidate will possess a minimum of 5 years of experience in a managed care environment, preferably hospital/physician.  Bachelor’s degree in healthcare administration, finance, or related field required, Master’s degree preferred.  Candidates should also have essential knowledge of managed care concepts, an understanding of the range of clinical services provided by hospitals, and project management experience.  The successful candidate will be a strong and effective communicator with proficiency in Microsoft Office, polished analytical skills, experience working collaboratively in a healthcare setting, and a commitment to excellent customer service.  Interested candidates can contact us and submit a resume.