Title: Director of Provider Contracting and Reimbursement
Yale Cancer Center, New Haven, CT, United States
Overview
In 1971, Yale University established Yale Health to provide health services to its staff, students, and faculty through a multidisciplinary health maintenance organization located on campus. Yale Health has approximately 49,000 members and is committed to an inclusive workplace.
Our state‑of‑the‑art facility at 55 Lock Street provides most of the care from over 150 providers in a 144,000 square‑foot building featuring more than 90 exam rooms, an Acute Care Department, a 15‑bed inpatient facility, a diagnostic imaging suite, and a full‑service retail pharmacy.
Responsibilities The role leads business strategy for Yale Health, a $500 million Yale University unit serving the University community, and partners with senior leadership to shape strategies that meet Yale’s current and future healthcare needs.
Oversee provider network configuration and development, manage external provider reimbursement, and maintain comprehensive knowledge of competitive healthcare reimbursement methodologies.
Design and lead claims processes, manage claims data and reporting, ensure quality and compliance, and drive continuous process improvement.
Develop, maintain, and optimize a comprehensive healthcare provider network to support the Yale University community, including proactive gap analysis and corrective action planning.
Build and manage relationships with external providers and internal stakeholders to support network design, configuration, and preferred site‑of‑care strategies.
Negotiate, renegotiate, and maintain contracts across all provider types, ensuring accurate documentation of terms, rates, and compliance with organizational standards.
Partner with legal, compliance, finance, and medical economics teams to structure, review, and remediate contracts and processes that protect Yale Health’s interests.
Oversee claims operations, including processing, auditing, training, quality assurance, and development of best practices that drive accuracy, efficiency, and continuous improvement.
Monitor and analyze claims and network performance data; develop dashboards, KPIs, and reporting to inform leadership decisions and operational strategy.
Ensure compliance with applicable laws, regulations, accreditation standards, and internal controls for claims, contracts, and provider network operations.
Lead initiatives to enhance infrastructure, automation, and scalability across network and claims functions.
Manage provider directory accuracy and related communication efforts, ensuring completeness and integrity of publicly accessible information.
Collaborate with university leaders, Yale Health chiefs and managers, and external partners to represent organizational needs, share best practices, and drive cross‑functional alignment.
Support value‑based care program design and provider reimbursement policy development, contributing to cost‑of‑care forecasting, financial planning, and premium alignment.
Perform additional duties as assigned by the Head of Finance and Business Strategy.
Schedule Full Time – 37.5 hrs; Weekdays, Monday – Friday, 8:30 am – 5:00 pm. Occasional evenings, weekends, holidays or recess may also be required. Hybrid Position.
Required Skills and Abilities
Advanced knowledge of provider network development and contracting, including provider reimbursement methodologies, rules, and industry norms.
Practical experience with healthcare claims and business rules. Operational knowledge related to providers claim reimbursement.
Knowledge of healthcare provider or health plan accounting/finance. Advanced knowledge of fiscal and regulatory compliance issues.
Well‑developed analytical, organizational, and research skills including use of data analytic tools. Ability to analyze financial reports and identify trends and variances.
Well‑developed managerial, decision‑making, planning, organizational, problem resolution and leadership skills. Excellent written and oral communication skills including presentation skills. Negotiation skills, including attention to detail.
Strong ability to lead, train and motivate staff, organize effective task forces, and project teams.
Proven ability to lead change, innovate processes, and drive results. Passion for leading in a challenging and changing environment utilizing innovation, technology, and best practices.
Preferred Skills and Abilities Three years of experience within a group practice and/or health plan.
Required Education and Experience Bachelor’s degree in a related field and 15 years of relevant experience or an equivalent combination of education and experience.
Background Check Requirements All candidates for employment will be subject to pre‑employment background screening, which may include motor vehicle, DOT certification, drug testing and credit checks based on the position description and job requirements. All offers are contingent upon the successful completion of the background check.
Health Requirements This role is a healthcare worker position. Healthcare workers (HCW) are defined as university employees working in a healthcare setting who have potential exposure to patients, human research subjects or infectious materials. HCW must meet health requirements before starting work, including MMR vaccine or immunity, varicella vaccine or immunity, TB screening, COVID vaccine according to University policy, hepatitis B vaccine or immunity, and annual flu vaccination.
Posting Disclaimer The intent of this job description is to provide a representative summary of the essential functions that will be required of the position and should not be construed as a declaration of specific duties and responsibilities of the position. Employees will be assigned specific job‑related duties through their hiring department.
University policy is committed to affirmative action under law in employment of women, minority group members, individuals with disabilities, and protected veterans. Additionally, in accordance with Yale's Policy Against Discrimination and Harassment, Yale does not discriminate against any individual on the basis of sex, sexual orientation, gender identity or expression, race, color, national or ethnic origin, religion, age, disability, status as a special disabled veteran, or veteran of the Vietnam era or other covered veteran.
Inquiries concerning Yale's Policy Against Discrimination and Harassment may be referred to the Office of Institutional Equity and Accessibility (OIEA).
Note Yale University is a tobacco‑free campus.
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Our state‑of‑the‑art facility at 55 Lock Street provides most of the care from over 150 providers in a 144,000 square‑foot building featuring more than 90 exam rooms, an Acute Care Department, a 15‑bed inpatient facility, a diagnostic imaging suite, and a full‑service retail pharmacy.
Responsibilities The role leads business strategy for Yale Health, a $500 million Yale University unit serving the University community, and partners with senior leadership to shape strategies that meet Yale’s current and future healthcare needs.
Oversee provider network configuration and development, manage external provider reimbursement, and maintain comprehensive knowledge of competitive healthcare reimbursement methodologies.
Design and lead claims processes, manage claims data and reporting, ensure quality and compliance, and drive continuous process improvement.
Develop, maintain, and optimize a comprehensive healthcare provider network to support the Yale University community, including proactive gap analysis and corrective action planning.
Build and manage relationships with external providers and internal stakeholders to support network design, configuration, and preferred site‑of‑care strategies.
Negotiate, renegotiate, and maintain contracts across all provider types, ensuring accurate documentation of terms, rates, and compliance with organizational standards.
Partner with legal, compliance, finance, and medical economics teams to structure, review, and remediate contracts and processes that protect Yale Health’s interests.
Oversee claims operations, including processing, auditing, training, quality assurance, and development of best practices that drive accuracy, efficiency, and continuous improvement.
Monitor and analyze claims and network performance data; develop dashboards, KPIs, and reporting to inform leadership decisions and operational strategy.
Ensure compliance with applicable laws, regulations, accreditation standards, and internal controls for claims, contracts, and provider network operations.
Lead initiatives to enhance infrastructure, automation, and scalability across network and claims functions.
Manage provider directory accuracy and related communication efforts, ensuring completeness and integrity of publicly accessible information.
Collaborate with university leaders, Yale Health chiefs and managers, and external partners to represent organizational needs, share best practices, and drive cross‑functional alignment.
Support value‑based care program design and provider reimbursement policy development, contributing to cost‑of‑care forecasting, financial planning, and premium alignment.
Perform additional duties as assigned by the Head of Finance and Business Strategy.
Schedule Full Time – 37.5 hrs; Weekdays, Monday – Friday, 8:30 am – 5:00 pm. Occasional evenings, weekends, holidays or recess may also be required. Hybrid Position.
Required Skills and Abilities
Advanced knowledge of provider network development and contracting, including provider reimbursement methodologies, rules, and industry norms.
Practical experience with healthcare claims and business rules. Operational knowledge related to providers claim reimbursement.
Knowledge of healthcare provider or health plan accounting/finance. Advanced knowledge of fiscal and regulatory compliance issues.
Well‑developed analytical, organizational, and research skills including use of data analytic tools. Ability to analyze financial reports and identify trends and variances.
Well‑developed managerial, decision‑making, planning, organizational, problem resolution and leadership skills. Excellent written and oral communication skills including presentation skills. Negotiation skills, including attention to detail.
Strong ability to lead, train and motivate staff, organize effective task forces, and project teams.
Proven ability to lead change, innovate processes, and drive results. Passion for leading in a challenging and changing environment utilizing innovation, technology, and best practices.
Preferred Skills and Abilities Three years of experience within a group practice and/or health plan.
Required Education and Experience Bachelor’s degree in a related field and 15 years of relevant experience or an equivalent combination of education and experience.
Background Check Requirements All candidates for employment will be subject to pre‑employment background screening, which may include motor vehicle, DOT certification, drug testing and credit checks based on the position description and job requirements. All offers are contingent upon the successful completion of the background check.
Health Requirements This role is a healthcare worker position. Healthcare workers (HCW) are defined as university employees working in a healthcare setting who have potential exposure to patients, human research subjects or infectious materials. HCW must meet health requirements before starting work, including MMR vaccine or immunity, varicella vaccine or immunity, TB screening, COVID vaccine according to University policy, hepatitis B vaccine or immunity, and annual flu vaccination.
Posting Disclaimer The intent of this job description is to provide a representative summary of the essential functions that will be required of the position and should not be construed as a declaration of specific duties and responsibilities of the position. Employees will be assigned specific job‑related duties through their hiring department.
University policy is committed to affirmative action under law in employment of women, minority group members, individuals with disabilities, and protected veterans. Additionally, in accordance with Yale's Policy Against Discrimination and Harassment, Yale does not discriminate against any individual on the basis of sex, sexual orientation, gender identity or expression, race, color, national or ethnic origin, religion, age, disability, status as a special disabled veteran, or veteran of the Vietnam era or other covered veteran.
Inquiries concerning Yale's Policy Against Discrimination and Harassment may be referred to the Office of Institutional Equity and Accessibility (OIEA).
Note Yale University is a tobacco‑free campus.
#J-18808-Ljbffr