Contract Director

The Director of Contracts will be primarily responsible for monitoring and reporting on performance against quality metrics in value-based contracts, optimizing and assisting in negotiating these contracts while also managing the credentialing function. This individual will evaluate, negotiate, secure, and maintain financially and administratively favorable managed care contracts with new and existing health plans/managed care organizations on behalf of Roya Health. The Director will also participate in and support the development of value-based contracting strategies and initiatives to adapt to ongoing healthcare payment reforms and evolving payment methodologies, including but not limited to commercial lines of business, payer contracts, value-based care initiatives, and CMS models/payment methodologies. Additionally, the Director will foster professional relationships with private and public payer executives and serve as the principal liaison between Roya Health and payers.

DUTIES AND RESPONSIBILITIES

• Lead the diversification and management of value-based contracts, ensuring they align with Roya Health's strategic plan. Develop strategies to support tracking and achievement of key performance metrics for optimal financial and clinical outcomes.
• Continuously analyze contract portfolios to identify risk areas and revenue opportunities. Implement strategies to enhance contract value, support retention, and maximize the impact of value-based care initiatives.
• Work across departments to align contract arrangements with clinical performance metrics and compliance requirements. Ensure consistent reporting and monitoring to meet contractual obligations.
• Direct negotiations, execution, and reviews of complex contracts to support Roya Health’s value-based care objectives. Ensure contracts incorporate mechanisms for effective metric tracking and include legal reviews to mitigate risk.
• Serve as the primary expert on value-based incentives, advising on the development of contract structures that support Roya Health’s goals. Provide insights on emerging trends in value-based care, payer relations, and payment models to guide strategy.
• Develop payer and network strategies aimed at enhancing business growth, quality of care, and cost competitiveness. Focus on creating contracts that prioritize robust tracking and reporting of value-based metrics.
• Establish and nurture strong relationships with market-based and national payers. Negotiate contracts that maximize client value and ensure measurable outcomes, fostering long-term collaboration.
• Lead the implementation of systems and processes to support tracking, monitoring, and reporting of value-based contract performance. Collaborate with internal teams to align operational infrastructure with contract management goals.
• Ensure accurate collection, validation, and reporting of data for tracking contract performance. Maintain a detailed database of utilization and payment information, benchmarking against industry standards to identify areas for improvement.
• Oversee contract compliance by monitoring health plan adherence to contract terms, managing reporting requirements, and addressing disputes. Ensure timely handling of contract anniversary dates and rate implementations.
• Research and evaluate new payer lines of business and potential contract acquisitions, focusing on those that enhance Roya Health’s value-based care initiatives. Adapt strategies as needed to respond to industry changes and evolving program needs.
• Oversee the provider credentialing process with health plans to ensure timely enrollment and compliance with value-based care requirements. Work to maximize revenue and prevent claim denials through efficient credentialing and re-credentialing procedures.
• Lead the development of data models to monitor total cost of care and healthcare spending. Provide actionable insights and strategic recommendations to optimize patient outcomes and support value-based care goals.

MINIMUM QUALIFICATIONS

• Bachelor’s degree in Business/Healthcare Administration or related field plus 5 years of related experience. Master’s degree preferred.
• Supervisory Experience: minimum of 5 years of leadership or managerial experience required.
• Proven experience in healthcare billing.
• Sound knowledge of health insurance providers.
• Experience in building sustainable partnerships between payers and providers.

KNOWLEDGE, SKILLS, ABILITIES

• Strategic, action-oriented leader with strong communication skills.
• Strong interpersonal and organizational skills.
• Able to translate corporate and division level strategies into clear market level action plans with defined goals and objectives for business operations.
• Establish and maintain positive and effective work relationships with a diverse network of physicians, administrative leadership and staff.
• Excellent verbal, written and interpersonal communication skills.
• Demonstrate leadership ability and skills in critical thinking, strategic planning, analysis and systems thinking.
• Ability to work independently and professionally in a fast-paced environment.
• Ability to maintain attendance to support required quality and quantity of work.
• Demonstrated ability to handle highly sensitive and confidential information in compliance with Health Insurance Portability and Accountability Act (HIPAA), and company confidentiality policies and procedures.
• Excellent verbal, written and interpersonal communication skills; highly collaborative team approach to work.

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