Director Payer Engagement

Overview

At SCA Health, we believe health care is about people – the patients we serve, the physicians we support and the teammates who push us forward. Behind every successful facility, procedure or innovation is a team of 15,000+ professionals working together, learning from each other and living out the mission, vision and values that define our organization. 

As part of Optum, SCA Health is redefining specialty care by developing more accessible, patient-centered practice solutions for a network of more than 370 ambulatory surgical centers, over 400 specialty physician practice clinics and numerous labs and surgical hospitals. Our work spans a broad spectrum of services, all designed to support physicians, health systems and employers in delivering efficient, value-based care to patients without compromising quality or autonomy.  

What sets SCA Health apart isn’t just what we do, it’s how we do it. Each decision we make is rooted in seven core values: 

• Clinical quality 
• Integrity 
• Service excellence 
• Teamwork 
• Accountability 
• Continuous improvement 
• Inclusion 

Our values aren’t empty words – they inform our attitudes, actions and culture. At SCA Health, your work directly impacts patients, physicians and communities. Here, you’ll find opportunities to build your career alongside a team that values your expertise, invests in your success, and shares a common mission to care for patients, serve physicians and improve health care in America.    

At SCA Health, we offer a comprehensive benefits package to support your health, well-being, and financial future. Our offerings include medical, dental, and vision coverage, 401k plan with company match, paid time off, life and disability insurance, and more. Please visit, https://careers.sca.health/why-sca, to learn more about our benefits.

Your ideas should inspire change. If you join our team, they will. 

Responsibilities

This Director Payer Engagement role with a focus in Health System Payer Support & Diligence is a remote position located within the United States.

Reporting to the Senior Vice President Payer Engagement & Strategy with dotted lines to market Senior Directors, the Director of Payer Engagement Health System Payer Support & Diligence will have responsibility for coordinating with health system joint ventures to obtain, assess, and interpret health system ASC payer contracts for loading into SCA Health contracting systems. Additionally, this role will have responsibility for conducting diligence on new acquisition and de novo opportunities, serving a clean team capacity.

Job Description / Key Responsibilities

• Serve as the primary support liaison for health system led payer related initiatives, acting as the single point of contact between internal stakeholders and health system payer teams for all payer related initiatives, communications, and contract matters.
• Lead and coordinate all payer related diligence activities for M&A, acting as the clean team to ensure sensitive payer-related information is protected. Ensure timely collection of information, rigorous tracking of open items, and clear communication of risks, assumptions, and mitigation strategies.
• Facilitate integration and de-integration activities across payer-related functions. Effectively manage deadlines, ensure deliverables are clearly documented and communicated to internal and external stakeholders.
• Leverage market intelligence and relevant data to facilitate data-driven decision making throughout the M&A lifecycle.
• Partner with payer contracting, operations, analytics, and revenue cycle teams to resolve payer issues, support implementation needs, and ensure accurate communication of payer contract changes.
• Obtain, review, validate, and process contract rate, fee schedule updates, and contract changes in collaboration with internal stakeholders throughout the life cycle of the health system relationship.
• Manage projects and workplans related to payer support for health systems, ensuring milestones, owners, and deliverables are clearly defined and executed on time.
• Provide subject matter expertise on payer strategies and operational implications for health system payer relationships.
• Facilitate the escalation of complex payer issues with health system partners to ensure swift resolution through stakeholder accountability and cross functional alignment.
• Monitor and maintain documentation, status reporting, and stakeholder communications related to payer support activities and diligence workstreams from problem identification through resolution.
• Continuously evaluate and enhance processes, identifying opportunities to strengthen alignment across stakeholders, improve performance, and elevate support for health system led payer related initiatives.

Qualifications

• Bachelor’s degree required
• 7+ years relevant work experience: Diligence, health plan contracting/healthcare operational/consulting experience, project management
• Strong knowledge of payer operations, reimbursement methodologies, contract terms, and health system payer relationships
• Demonstrated project management skills, including the ability to organize workstreams, track deliverables, manage timelines, and coordinate cross-functional stakeholders
• Ability to review, validate, and coordinate updates to contract rates, fee schedules, and related payer terms with a high degree of accuracy and critical thinking
• Strong communication and relationship management skills with the ability to serve as a trusted single point of contact for health system payer teams
• Strong analytical skills, along with expertise in Microsoft products required
• Excellent communication skills, both verbal and written
• Travel required – 5-10%

USD $160,000.00/Yr. USD $180,000.00/Yr.